Provider Demographics
NPI:1972517027
Name:LIGGETT, CHARLES LEE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEE
Last Name:LIGGETT
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 1:402 SOUTH LEE STREET
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-1196
Mailing Address - Country:US
Mailing Address - Phone:870-798-4299
Mailing Address - Fax:870-798-2425
Practice Address - Street 1:402 SOUTH LEE STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744-1196
Practice Address - Country:US
Practice Address - Phone:870-798-4299
Practice Address - Fax:870-798-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0026189174400000X
ARE0197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD44168Medicare UPIN