DR. CHARLES DOUGLAS EDMONDSON M.D. NPI 1669589040

NPI Information

NPI: 1669589040
Provider Name: DR. CHARLES DOUGLAS EDMONDSON, M.D.
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
700 W GROVE ST
EL DORADO, AR
ZIP 71730
Phone: (870) 862-1577
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DR. Charles Douglas Edmondson, M.D. is a specialist in El Dorado, AR. The provider is 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. DR. Charles Douglas Edmondson, M.D. NPI is 1669589040. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

700 W GROVE ST
EL DORADO, AR
ZIP 71730-416
Phone: (870) 862-1577

The enumeration date for this NPI number is 8/23/2006 and was last updated on 10/15/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		C5187	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5K900C070	MEDICARE PIN	ARKANSAS
2	D86190	MEDICARE UPIN	ARKANSAS
3	710813069	OTHER	ARKANSAS	FED. TAX ID #
4	C5187	OTHER	ARKANSAS	MEDICAL ST. LICENSE #
5	134936001	MEDICAID	ARKANSAS
6	5C070	OTHER	ARKANSAS	GRP'S MCARE PROV.#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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