Individual
DR. CHARLES TED PAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1245 WESTGATE PKWY, DOTHAN, AL 36303
(334) 793-9595
(334) 793-1578
Mailing address
1245 WESTGATE PKWY, DOTHAN, AL 36303
(334) 793-9595
(334) 793-1578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6629
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000004912
—
AL
05
—
000018990
—
AL
01
—
051004912
BLUE CROSS
AL
01
—
051018990
BLUE CROSS
AL
Enumeration date
12/28/2005
Last updated
11/12/2009
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