MEDICARE: BARBARA A, SANDEFUR 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
1	2085R0202X	Diagnostic Radiology Physician	R3146	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55822	OTHER	AR	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982647616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA A, SANDEFUR M.D.

Provider Business Mailing Address
First Line	:	500 SOUTH UNIVERSITY
Second Line	:	SUITE 600
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5324
Country	:	US
Telephone Number	:	501-664-3914
Fax Number	:	501-664-5246

Provider Business Practice Location Address
First Line	:	500 SOUTH UNIVERSITY
Second Line	:	SUITE 101
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-5324
Country	:	US
Telephone Number	:	501-664-3914
Fax Number	:	501-664-5246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/18/2012

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