Provider Demographics
NPI:1396854642
Name:EDWIN N. BARRON JR. MD PA
Entity Type:Organization
Organization Name:EDWIN N. BARRON JR. MD PA
Other - Org Name:OFFICE PARK FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ELWYN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:PERSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-9222
Mailing Address - Street 1:7 OFFICE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3862
Mailing Address - Country:US
Mailing Address - Phone:501-225-9222
Mailing Address - Fax:501-225-8564
Practice Address - Street 1:7 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3862
Practice Address - Country:US
Practice Address - Phone:501-225-9222
Practice Address - Fax:501-225-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC67803Medicare UPIN
ARH06101Medicare UPIN