Healthcare Provider Details

I. General information

NPI: 1578143780
Provider Name (Legal Business Name): NICHOLAS JOHN BALTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 400
LITTLE ROCK AR
72205-6399
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR STE 400
LITTLE ROCK AR
72205-6399
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-2141
  • Fax: 501-224-0506
Mailing address:
  • Phone: 501-224-2141
  • Fax: 501-224-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-19722
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: