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Dr. Charles Douglas Edmondson, MD
Specialist in El Dorado, Arkansas
NPI 1669589040

Charles Douglas Edmondson is a Specialist based in El Dorado, AR. Charles Douglas Edmondson practices in El Dorado, AR and has the professional credentials of MD. The NPI Number for Charles Douglas Edmondson is 1669589040 and holds a License No. C5187 (Arkansas).

The current practice location address for Charles Douglas Edmondson is 700 W Grove St, El Dorado, AR and can be reached out via phone at 870-862-1577.

Location: 700 W Grove St, El Dorado, AR, 71730-4557
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1669589040
Provider Name
Charles Douglas Edmondson
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
700 W Grove St, El Dorado, AR, 71730-4557
Phone Number
870-862-1577
Fax Number
Provider Enumeration Date
08/23/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
710813069 01 AR FED. TAX ID #
134936001 05 AR
C5187 01 AR MEDICAL ST. LICENSE #
5C070 01 AR GRP'S MCARE PROV.#
institution
Provider Business Practice Location Address Details
Address
700 W Grove St
City
El Dorado
State
Arkansas
Zip
71730-4416
Phone Number
870-862-1577
Fax Number
person
Provider Business Mailing Address Details
Address
700 W Grove St
City
El Dorado
State
Arkansas
Zip
71730-4416
Phone Number
870-862-1577
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
C5187 (Arkansas)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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