Individual
DR. CHARLES LAWRENCE MADDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6431 FANNIN ST, EMERGENCY MEDICINE JJL 4TH FLOOR, HOUSTON, TX 77030-1501
(713) 500-7668
Mailing address
6431 FANNIN ST, EMERGENCY MEDICINE JJL 450 J, HOUSTON, TX 77030-1501
(713) 500-7668
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
220874
NY
207P00000X
Emergency Medicine Physician
Primary
FTL 42805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02165740
—
NY
05
—
205110401
—
TX
01
—
205110402
CSHCN
TX
01
—
8V3107
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/13/2006
Last updated
06/15/2010
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