Provider Demographics
NPI:1982647616
Name:SANDEFUR, BARBARA A, (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A,
Last Name:SANDEFUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTH UNIVERSITY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5324
Mailing Address - Country:US
Mailing Address - Phone:501-664-3914
Mailing Address - Fax:501-664-5246
Practice Address - Street 1:500 SOUTH UNIVERSITY
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5324
Practice Address - Country:US
Practice Address - Phone:501-664-3914
Practice Address - Fax:501-664-5246
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR31462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR55822OtherBCBS PROVIDER NUMBER
AR121991001Medicaid
AR55822OtherBCBS PROVIDER NUMBER
ARB56271Medicare UPIN