Individual
CHARLES E MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7501 LAKEVIEW PKWY, STE 160, ROWLETT, TX 75088-9322
(972) 526-0340
(972) 996-1857
Mailing address
PO BOX 226, ROWLETT, TX 75030-0226
(972) 526-0340
(972) 996-1857
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
J3349
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117454204
—
TX
05
—
117454205
—
TX
01
—
8BX668
BLUE CROSS BLUE SHIELD
TX
01
—
8U7632
BLUE CROSS BLUE SHIELD
TX
01
—
P00295238
RAILROAD MEDICARE
TX
Enumeration date
04/03/2006
Last updated
03/20/2012
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