Individual
CHARLES MATTHEW MENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4728 E. LANCASTER AVE., FORT WORTH, TX 76103-3638
(817) 413-0943
(817) 413-6481
Mailing address
4728 E LANCASTER AVE, FORT WORTH, TX 76103-3836
(817) 413-0943
(817) 413-6481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193740101
—
TX
01
—
8N8358
BLUE CROSS BLUE SHIELD
TX
01
—
P00342395
RAILROAD MEDICARE
TX
Enumeration date
01/30/2006
Last updated
08/21/2008
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