Provider Demographics
NPI:1942275334
Name:KLEPPER, CHARLES ROY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROY
Last Name:KLEPPER
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 1:707 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2912
Mailing Address - Country:US
Mailing Address - Phone:870-741-3592
Mailing Address - Fax:870-741-7733
Practice Address - Street 1:707 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2912
Practice Address - Country:US
Practice Address - Phone:870-741-3592
Practice Address - Fax:870-741-7733
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4948207Q00000X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101296001Medicaid
AR52939Medicare ID - Type Unspecified
AR101296001Medicaid