Healthcare Provider Details

I. General information

NPI: 1942275334
Provider Name (Legal Business Name): CHARLES ROY KLEPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MAIN ST
HARRISON AR
72601-2912
US

IV. Provider business mailing address

707 N MAIN ST
HARRISON AR
72601-2912
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-3592
  • Fax: 870-741-7733
Mailing address:
  • Phone: 870-741-3592
  • Fax: 870-741-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC4948
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC4948
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC4948
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: