Provider Demographics
NPI:1821037383
Name:SPEIGHTS, CHARLES RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RANDOLPH
Last Name:SPEIGHTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SPEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948
Mailing Address - Country:US
Mailing Address - Phone:512-771-6664
Mailing Address - Fax:
Practice Address - Street 1:1727 IMPERIAL BLVD BLDG 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5393
Practice Address - Country:US
Practice Address - Phone:337-485-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14774R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1461741Medicaid
LAH63272Medicare UPIN
LA1461741Medicaid