Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | E3783 | AR |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | E3783 | AR |
NPI | 1063477651 |
---|---|
Provider Name | Dr. Charles Kristian Hanby |
First Address | Fayetteville, AR 72702-1608 |
Second Address | Fayetteville, AR 72703-4056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H84523 | (02) | AR |