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NPI Code Detail

MEDICARE: CHARLES LANE ANZALONE JR. M.D.

MEDICARE: CHARLES LANE ANZALONE JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology PhysicianT2020-103AR

General Provider Information

NPI Number : 1477932861
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LANE ANZALONE JR. M.D.
Provider Business Mailing Address
First Line : 4301 W MARKHAM ST # 783
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7101
Country : US
Telephone Number : 501-686-8000
Fax Number : 501-526-5148
Provider Business Practice Location Address
First Line : 1000 W PINHOOK RD STE 201
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2464
Country : US
Telephone Number : 337-237-0650
Fax Number : 888-990-2781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2015
Last Update Date : 07/07/2021

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