Provider Demographics
NPI:1598227787
Name:LUTZ, BAILEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BAILEE
Middle Name:
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BAILEE
Other - Middle Name:
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6636 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0766
Mailing Address - Country:US
Mailing Address - Phone:479-361-4631
Mailing Address - Fax:
Practice Address - Street 1:6636 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0766
Practice Address - Country:US
Practice Address - Phone:479-361-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE15123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE15123OtherARKANSAS STATE MEDICAL BOARD