Provider Demographics
NPI:1225006497
Name:BALTZ, KATHERINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:H
Last Name:BALTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 W. MARKHAM
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3528
Mailing Address - Country:US
Mailing Address - Phone:501-664-5354
Mailing Address - Fax:501-664-5257
Practice Address - Street 1:5300 W. MARKHAM
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3528
Practice Address - Country:US
Practice Address - Phone:501-664-5354
Practice Address - Fax:501-664-5257
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1608207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5L040Medicare ID - Type Unspecified
ARG886206Medicare UPIN