Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | G4093 | TX |
Y | 207VX0201X | Gynecologic Oncologist | G4093 | TX |
NPI | 1477512119 |
---|---|
Provider Name | Dr. Charles Vernon Capen |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807559 | BLUE SHIELD (01) | TX |
C14167 | (02) | TX |