Provider Demographics
NPI:1881667921
Name:BALDRIDGE, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BALDRIDGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:650 S SHACKLEFORD RD
Mailing Address - Street 2:SUITE 439
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3527
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-552-4777
Practice Address - Fax:501-552-4570
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC-4010207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103990001Medicaid
AR33-00204OtherUNITED HEALTHCARE
AR103990001Medicaid
AR5M431Medicare ID - Type Unspecified