Healthcare Provider Details

I. General information

NPI: 1144225145
Provider Name (Legal Business Name): LUIS F BARANDIARAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LESLIE ST STE 6
NASHVILLE AR
71852-4000
US

IV. Provider business mailing address

PO BOX 508
NASHVILLE AR
71852-0508
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-3757
  • Fax: 870-451-9713
Mailing address:
  • Phone: 870-845-3757
  • Fax: 870-451-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE3582
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: