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General NPI Number Information
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NPI Number | 1164484614
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Entity Type | Individual
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Provider Name | BRAD PATRICK BALTZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1300 CENTERVIEW DR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4349
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Country | US
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Telephone | 501-508-7163
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Fax | 501-203-9850
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 239-236-2775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C7454
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | C-7454
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License Number State | AR
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