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Individual

DR. CHARLES WAYNE CALVERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
546 E SANDY LAKE RD, SUITE 210, COPPELL, TX 75019-5786
(972) 258-7426
(972) 870-4926
Mailing address
546 E SANDY LAKE RD, SUITE 210, COPPELL, TX 75019-5786
(972) 258-7426
(972) 870-4926

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6063
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
197724103
TX
01
368267YZNA
MEDICARE
TX
Enumeration date
05/02/2007
Last updated
03/10/2016
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