Individual
CHARLES M PERRICONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 ZEID BLVD, HENDERSON, TX 75652-6070
(903) 657-7583
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G8337
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130797705
—
TX
05
—
130797708
—
TX
01
—
75-1976930-005
TRICARE
TX
01
—
75-2616977-015
TRICARE
TX
01
—
75-2616977-017
TRICARE
TX
01
—
75-2616977-043
TRICARE
TX
01
—
75-2616977-066
TRICARE
TX
01
—
8GF477
BCBS
TX
01
—
P01754641
RAIL ROAD MEDICARE
TX
Enumeration date
02/17/2006
Last updated
05/29/2024
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