Provider Demographics
NPI:1568491892
Name:MCCLAIN, CHARLES MORRIS III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MORRIS
Last Name:MCCLAIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1490 BYERS ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-5831
Mailing Address - Country:US
Mailing Address - Phone:870-793-2207
Mailing Address - Fax:870-793-8002
Practice Address - Street 1:1710 HARRISON ST
Practice Address - Street 2:WHITE RIVER MEDICAL CENTER
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7303
Practice Address - Country:US
Practice Address - Phone:870-262-3125
Practice Address - Fax:870-793-8002
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE37132085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH90301Medicare UPIN
AR5M578Medicare ID - Type Unspecified