Provider Demographics
NPI:1770590531
Name:CHARLES, RONALD A (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:CHARLES
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 1:2951 MARINA BAY DR
Mailing Address - Street 2:SUITE 130, #145
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2735
Mailing Address - Country:US
Mailing Address - Phone:832-758-1999
Mailing Address - Fax:
Practice Address - Street 1:4141 NORTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-4208
Practice Address - Country:US
Practice Address - Phone:832-582-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24830207P00000X
TXJ0811207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104679911Medicaid
TX1770590531OtherBCBSTX
TX1770590531OtherTRICARE
TX8L17217Medicare PIN
TX1770590531OtherBCBSTX
F88226Medicare UPIN