Provider Demographics
NPI:1437233186
Name:LETT, CHARLES LEONARD SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEONARD
Last Name:LETT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1013 MEDICAL CENTER PKWY
Mailing Address - Street 2:BUILDING 1 SUITE A
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6742
Mailing Address - Country:US
Mailing Address - Phone:334-875-4374
Mailing Address - Fax:334-875-4340
Practice Address - Street 1:1013 MEDICAL CENTER PKWY
Practice Address - Street 2:BUILDING 1 SUITE A
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6742
Practice Address - Country:US
Practice Address - Phone:334-875-4374
Practice Address - Fax:334-875-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL8713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51002287OtherBLUE CROSS
AL5299248030Medicaid
AL0529Medicare ID - Type Unspecified
AL5299248030Medicaid