Healthcare Provider Details

I. General information

NPI: 1346736337
Provider Name (Legal Business Name): PEDRO SOIBELMANN TETELBOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 08/21/2024
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RETINA ASSOCIATES, P.A. 9800 BAPTIST HEALTH DRIVE, SUITE 200
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

9800 BAPTIST HEALTH DRIVE SUITE 200
LITTLE ROCK AR
72205-6243
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-0900
  • Fax: 501-312-4750
Mailing address:
  • Phone: 501-219-0900
  • Fax: 501-312-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE-15207
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberE15207
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: