Individual
CHARLES B. GOVER-MENDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J9689
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1052540-02
—
TX
Enumeration date
07/08/2005
Last updated
08/28/2024
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