Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | H8428 | TX |
NPI | 1003830290 |
---|---|
Provider Name | Charles W Sponsel |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E67875 | (02) |