Provider Demographics
NPI:1255600441
Name:CHARLES L LIGGETT JR MD PA
Entity type:Organization
Organization Name:CHARLES L LIGGETT JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGGETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD PA
Authorized Official - Phone:325-823-3209
Mailing Address - Street 1:101 AVE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2113
Mailing Address - Country:US
Mailing Address - Phone:325-823-3209
Mailing Address - Fax:325-823-3600
Practice Address - Street 1:101 AVE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2113
Practice Address - Country:US
Practice Address - Phone:325-823-3209
Practice Address - Fax:325-823-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2324TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CY181OtherBCBS
TX207323101OtherFIRSTCARE
TXD44168Medicare UPIN