Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | M7907 | TX |
N | 208600000X | Surgeon | M7907 | TX |
Y | 2086S0129X | Vascular Surgeon | M7907 | TX |
NPI | 1104995828 |
---|---|
Provider Name | Dr. Kristofer M Charlton-Ouw |
First Address | Houston, TX 77004-6999 |
Second Address | Houston, TX 77004-6999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193793005 | (05) | TX |