Provider Demographics
NPI:1144225145
Name:BARANDIARAN, LUIS F (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:BARANDIARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0508
Mailing Address - Country:US
Mailing Address - Phone:870-845-3757
Mailing Address - Fax:870-451-9713
Practice Address - Street 1:900 LESLIE ST
Practice Address - Street 2:STE 6
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-4000
Practice Address - Country:US
Practice Address - Phone:870-845-3757
Practice Address - Fax:870-451-9713
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3582208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770278701OtherBREASTCARE
AR800040342OtherTRICARE
P00053036OtherRAILROAD MEDICARE
AR148816001Medicaid
ARE3582OtherAR MEDICAL BOARD LIC
AR03030015400OtherQUAL CHOICE
B211082Medicare UPIN
AR770278701OtherBREASTCARE