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General NPI Number Information
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NPI Number | 1346736337
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Entity Type | Individual
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Provider Name | PEDRO SOIBELMANN TETELBOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | RETINA ASSOCIATES, P.A. 9800 BAPTIST HEALTH DRIVE, SUITE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-219-0900
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Fax | 501-312-4750
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Provider Business Mailing Address
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Address Line | 9800 BAPTIST HEALTH DRIVE SUITE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6243
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Country | US
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Telephone | 501-219-0900
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Fax | 501-312-4750
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E-15207
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | E15207
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License Number State | AR
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