Provider Demographics
NPI:1063408409
Name:CESARE, CHARLES D SR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:CESARE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1110 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4164
Practice Address - Country:US
Practice Address - Phone:870-205-2000
Practice Address - Fax:870-205-2001
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS9601174400000X
ARE7806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS81301OtherARK BCBS
MS00114569Medicaid
MS111171001OtherARK MEDICAID
AR111171001Medicaid
MS00114569Medicaid