Provider Demographics
NPI:1174560726
Name:VINSON, CHARLES ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERIC
Last Name:VINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 BRANCH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3304
Mailing Address - Country:US
Mailing Address - Phone:817-360-6242
Mailing Address - Fax:
Practice Address - Street 1:3201 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2450
Practice Address - Country:US
Practice Address - Phone:903-654-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7341207P00000X
TXJ0714207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L907OtherBCBS
AR143760001Medicaid
TX146793801Medicaid
TX146793801Medicaid
AR5L907Medicare PIN
TX8623N6Medicare ID - Type Unspecified