Provider Demographics
NPI:1477932861
Name:ANZALONE, CHARLES LANE JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LANE
Last Name:ANZALONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:1000 W PINHOOK RD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2464
Practice Address - Country:US
Practice Address - Phone:337-237-0650
Practice Address - Fax:888-990-2781
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ART2020-103207Y00000X
MNL942161058815207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology