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NPI Code Detail

MEDICARE: REBEKAH GRACE BALTZ M.D.

MEDICARE: REBEKAH GRACE BALTZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianE-11420AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1E-11420OTHERARMEDICAL LICENSE

General Provider Information

NPI Number : 1992119770
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBEKAH GRACE BALTZ M.D.
Provider Business Mailing Address
First Line : 1651 E STEARNS ST STE 110
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-6196
Country : US
Telephone Number : 479-876-8550
Fax Number : 479-208-4266
Provider Business Practice Location Address
First Line : 1651 E STEARNS ST STE 110
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-6196
Country : US
Telephone Number : 479-876-8550
Fax Number : 479-208-4266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2014
Last Update Date : 11/03/2025

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Directions to “ REBEKAH GRACE BALTZ M.D.” Practice Location

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