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NPI Code Detail

MEDICARE: PEDRO SOIBELMANN TETELBOM M.D.

MEDICARE: PEDRO SOIBELMANN TETELBOM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207W00000XOphthalmology PhysicianE-15207AR
3207WX0107XRetina Specialist (Ophthalmology) PhysicianE15207AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346736337
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEDRO SOIBELMANN TETELBOM M.D.
Provider Business Mailing Address
First Line : 9800 BAPTIST HEALTH DRIVE
Second Line : SUITE 200
City : LITTLE ROCK
State : AR
Zip : 72205-6243
Country : US
Telephone Number : 501-219-0900
Fax Number : 501-312-4750
Provider Business Practice Location Address
First Line : RETINA ASSOCIATES, P.A.
Second Line : 9800 BAPTIST HEALTH DRIVE, SUITE 200
City : LITTLE ROCK
State : AR
Zip : 72205-7101
Country : US
Telephone Number : 501-219-0900
Fax Number : 501-312-4750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2018
Last Update Date : 08/21/2024

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Directions to “ PEDRO SOIBELMANN TETELBOM M.D.” Practice Location

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