Provider Demographics
NPI:1164482592
Name:NAYLES, LEE CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:CHARLES
Last Name:NAYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165456
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72216
Mailing Address - Country:US
Mailing Address - Phone:501-371-0055
Mailing Address - Fax:501-371-0088
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5036
Practice Address - Country:US
Practice Address - Phone:501-371-0055
Practice Address - Fax:501-371-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103668001Medicaid
53850Medicare ID - Type Unspecified
AR103668001Medicaid