Individual
DR. CHARLES R PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5016 S US HWY 75, RADIOLOGY DEPARTMENT, DENISON, TX 75020-4584
(903) 892-1131
(903) 327-8023
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-4040
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
F7884
TX
2085R0202X
Diagnostic Radiology Physician
Primary
F7884
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104802702
—
TX
Enumeration date
12/29/2005
Last updated
09/22/2021
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