Provider Demographics
NPI:1649254129
Name:KILPATRICK, CHARLES (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:KILPATRICK
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1325
Mailing Address - Country:US
Mailing Address - Phone:903-927-6950
Mailing Address - Fax:903-927-6954
Practice Address - Street 1:815 S WASHINGTON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5369
Practice Address - Country:US
Practice Address - Phone:903-927-6950
Practice Address - Fax:903-927-6954
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114640902Medicaid
TX114640902Medicaid