Provider Demographics
NPI:1235148719
Name:BELT, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:904 E RODGERS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-4456
Mailing Address - Country:US
Mailing Address - Phone:479-587-8039
Mailing Address - Fax:
Practice Address - Street 1:525 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3110
Practice Address - Country:US
Practice Address - Phone:479-575-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50404Medicare ID - Type Unspecified
ARD84061Medicare UPIN