Provider Demographics
NPI:1275529851
Name:CHAPPELL, CAROL W (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:W
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 SAINT VINCENT CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5412
Mailing Address - Country:US
Mailing Address - Phone:501-661-1123
Mailing Address - Fax:501-661-0046
Practice Address - Street 1:5 SAINT VINCENT CIR
Practice Address - Street 2:STE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5412
Practice Address - Country:US
Practice Address - Phone:501-661-1123
Practice Address - Fax:501-661-0046
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4804207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
50981OtherBLUE CROSS BLUE SHIELD
14216000000OtherQUAL CHOICCOFAR
14216000000OtherQUAL CHOICCOFAR
50981OtherBLUE CROSS BLUE SHIELD
D04441Medicare UPIN