Individual
CHARLES CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6411 FANNIN ST, HOUSTON, TX 77030-1501
(713) 500-5154
Mailing address
6411 FANNIN ST, HOUSTON, TX 77030-1501
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
BP10042269
TX
Other
Enumeration date
06/06/2011
Last updated
08/08/2012
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