Healthcare Provider Details

I. General information

NPI: 1316009731
Provider Name (Legal Business Name): BARRY F URETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 MARHAM AVENUE S-304 SHOREY BUILDING
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

4301 W MARKHAM ST S-304 SHOREY BUILDING
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-1267
  • Fax: 501-257-5796
Mailing address:
  • Phone: 501-688-9417
  • Fax: 501-257-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK1155
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE5214
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: