Individual
DR. CHARLES A. SHOULTZ III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7125 NEW SANGER AVE STE A, WACO, TX 76712-4054
(254) 399-5400
(254) 772-8669
Mailing address
PO BOX 21327, WACO, TX 76702-1327
(254) 399-5400
(254) 772-8669
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
J6243
TX
207RI0011X
Interventional Cardiology Physician
Primary
J6243
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100345101
FIRSTCARE
TX
05
—
117613301
—
TX
05
—
117613302
—
TX
01
—
1221938
FIRSTHEALTH
TX
01
—
142799902
UNITED HEALTHCARE
TX
01
—
4559831
AETNA
TX
01
—
74178408876712A004
TRICARE
TX
01
—
83W040
BLUE CROSS
TX
01
—
90032
SWHP
TX
Enumeration date
06/27/2005
Last updated
11/10/2023
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