Provider Demographics
NPI:1780812172
Name:MAJKA, CHARLES LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LESLIE
Last Name:MAJKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 W EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3745
Mailing Address - Country:US
Mailing Address - Phone:940-627-8982
Mailing Address - Fax:940-627-7597
Practice Address - Street 1:1306 13TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2454
Practice Address - Country:US
Practice Address - Phone:940-683-5287
Practice Address - Fax:940-683-4382
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9594207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN9594OtherSTATE LICENSE
TX328485301Medicaid