Provider Demographics
NPI:1639362593
Name:HAROLD H. CHAKALES, M. D., P. A.
Entity Type:Organization
Organization Name:HAROLD H. CHAKALES, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-664-1500
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5417
Mailing Address - Country:US
Mailing Address - Phone:501-664-1500
Mailing Address - Fax:501-664-8529
Practice Address - Street 1:5 SAINT VINCENT CIR STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5417
Practice Address - Country:US
Practice Address - Phone:501-664-1500
Practice Address - Fax:501-664-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR1749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104006001Medicaid