Charles Baker Mallett III, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

F1769 Issued in TX

Practice address

4007 James Casey Street
Suite A200
Austin, TX 78745-3361

Phone

(512) 441-4400

Fax

(512) 441-7421

NPI assigned

Dec 28, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291075200000",
    "number": "1558348979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4007 JAMES CASEY STREET",
            "address_2": "SUITE A200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787453361",
            "telephone_number": "512-441-4400",
            "fax_number": "512-441-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 JAMES CASEY STREET",
            "address_2": "SUITE A200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787453361",
            "telephone_number": "512-441-4400",
            "fax_number": "512-441-7421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLETT",
        "first_name": "CHARLES",
        "middle_name": "BAKER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2010-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F1769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111529701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaugn Mallari
• Joseph J Malleske, M.D.
• Katherine Jessieanne Mallet
• Paul K Mallet, CRNA
• Mallett MD, PA
• Ashley Malley, AUD
• Jonathan Malley, LMFT
• Avantika Mallik, MD
• Rebecca T Mallory Calhoun, SLP
• Mallory Lynch, OD, PLLC

• Family Medicine Physician in Austin, TX
• Providers in Austin, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.