Provider Demographics
NPI:1881683464
Name:BALTZ, ALBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:L
Last Name:BALTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2901 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-9438
Mailing Address - Country:US
Mailing Address - Phone:870-892-4467
Mailing Address - Fax:870-892-4407
Practice Address - Street 1:2901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9438
Practice Address - Country:US
Practice Address - Phone:870-892-4467
Practice Address - Fax:870-892-4407
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC4088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC67781Medicare UPIN
AR50260Medicare ID - Type Unspecified