Individual
DR. CHARLES MATTHIAS MOUCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1304 WONDER WORLD DR, SAN MARCOS, TX 78666-7532
(855) 876-7246
(855) 277-5070
Mailing address
PO BOX 208354, DALLAS, TX 75320-8354
(512) 485-7208
(844) 364-8678
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
S9941
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1S5315
TEXAS MEDICARE
TX
01
—
1S5318
TEXAS MEDICARE
TX
01
—
S9941
TEXAS MEDICAL LICENSE
TX
Enumeration date
06/03/2016
Last updated
03/08/2023
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