| Doctor Name: | CHARLES L SECREST |
| NPI Number: | 1588695654 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | B29973 |
| Business Practice Address: | 703 E Marshall Ave Suite 5007 Longview, TX - 756015500 |
| Business Phone Number: | 9033154455 |
| Business Fax Number: | 9033152466 |
| Mailing Address: | Po Box 731218, DALLAS |
| State: | TX |
| Postal Code: | 753731218 |
| Phone Number: | 9033154455 |
| Fax Number: | 9033152466 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 09/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | B29973 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |