Healthcare Provider Details

I. General information

NPI: 1932350683
Provider Name (Legal Business Name): JUAN CAMILO BARRETO ANDRADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

IV. Provider business mailing address

PO BOX 55050
LITTLE ROCK AR
72215-5050
US

V. Phone/Fax

Practice location:
  • Phone: 501-906-3000
  • Fax:
Mailing address:
  • Phone: 501-906-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036.130226
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberE-9267
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: