Provider Demographics
NPI:1558592543
Name:JOHN TYLER BABER, M.D. P.A.
Entity Type:Organization
Organization Name:JOHN TYLER BABER, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-663-9420
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5303
Mailing Address - Country:US
Mailing Address - Phone:501-663-9420
Mailing Address - Fax:501-663-9470
Practice Address - Street 1:500 S UNIVERSITY AVE STE 103
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5303
Practice Address - Country:US
Practice Address - Phone:501-663-9420
Practice Address - Fax:501-663-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB89925Medicare UPIN