Edmondson, Charles Douglas

Edmondson, Charles Douglas is an individual health care provider with primary practice located at 700 W Grove St , El Dorado AR 71730-4416. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Edmondson, Charles Douglas can be contacted via phone (870) 862-1577.

Contact Information

Primary practice address
700 W Grove St El Dorado AR 71730-4416
Phone: (870) 862-1577
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X C5187 Arkansas

Profile Details

NPI number 1669589040
LBN Legal business name Edmondson, Charles Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2006
Last updated Oct 15th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669589040 NPPES
Arkansas Other 710813069 FED. TAX ID #
Arkansas MEDICAID 134936001 FED. TAX ID #
Arkansas Other C5187 FED. TAX ID #
Arkansas Other 5C070 FED. TAX ID #

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