Provider Demographics
NPI:1730162645
Name:LOBO, CHARMAINE R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:R
Last Name:LOBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3131
Mailing Address - Country:US
Mailing Address - Phone:817-281-0402
Mailing Address - Fax:817-281-6364
Practice Address - Street 1:1709 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3131
Practice Address - Country:US
Practice Address - Phone:817-281-0402
Practice Address - Fax:817-281-6364
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203805207Q00000X
TXN3841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103837Medicaid
TX209273601Medicaid
TX209273601Medicaid
MA0103837Medicaid
TX8L22988Medicare PIN