Provider Demographics
NPI:1629039037
Name:THOMASON, CHARLIE M (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:M
Last Name:THOMASON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4980
Mailing Address - Country:US
Mailing Address - Phone:501-327-6665
Mailing Address - Fax:501-730-0289
Practice Address - Street 1:525 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-327-6665
Practice Address - Fax:501-730-0289
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR45056207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y722Medicare ID - Type Unspecified