Healthcare Provider Details

I. General information

NPI: 1235751892
Provider Name (Legal Business Name): MARIA GABRIELA URDANETA PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD STE 501
LITTLE ROCK AR
72205-6389
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-9080
  • Fax: 501-227-0410
Mailing address:
  • Phone: 501-227-9080
  • Fax: 501-227-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-20396
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: