Provider Demographics
NPI:1912149733
Name:CHARLES D. LEFLER M.D. ,P.A
Entity type:Organization
Organization Name:CHARLES D. LEFLER M.D. ,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-884-4134
Mailing Address - Street 1:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-1689
Mailing Address - Country:US
Mailing Address - Phone:828-891-5524
Mailing Address - Fax:828-891-4069
Practice Address - Street 1:89 MEDICAL PARK DR
Practice Address - Street 2:STE A
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3035
Practice Address - Country:US
Practice Address - Phone:828-884-4134
Practice Address - Fax:828-884-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51592OtherBCBS
NC5911937Medicaid
NC5911937Medicaid
NC51592OtherBCBS