Provider Demographics
NPI:1881679033
Name:BALTZ, TRACY C (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:BALTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 EXECUTIVE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:201 EXECUTIVE CT
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4536
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-09-13
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Provider Licenses
StateLicense IDTaxonomies
ARE1801207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145620001Medicaid
AR145620001Medicaid
5K971Medicare ID - Type Unspecified