Provider Demographics
NPI:1013945138
Name:CRAFT, CHARLES W (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:CRAFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7003 CHAD COLLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-3000
Mailing Address - Country:US
Mailing Address - Phone:479-431-3500
Mailing Address - Fax:479-452-2098
Practice Address - Street 1:7003 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-3000
Practice Address - Country:US
Practice Address - Phone:479-431-3500
Practice Address - Fax:479-452-2098
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-5840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010029987OtherRR MEDICARE
AR118096003Medicaid
AR118096003Medicaid
010029987OtherRR MEDICARE