Provider Demographics
NPI:1245345958
Name:CHARLES ROY KLEPPER ET AL PTRS
Entity type:Organization
Organization Name:CHARLES ROY KLEPPER ET AL PTRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-741-3592
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B704OtherARK. BLUE SHIELD
AR127780002Medicaid
AR127780002Medicaid
ARCF9957Medicare ID - Type UnspecifiedRAILROAD MEDICARE