1316009731 NPI number — BARRY F URETSKY MD

Table of content: BARRY F URETSKY MD (NPI 1316009731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316009731 NPI number — BARRY F URETSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URETSKY
Provider First Name:
BARRY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316009731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 W MARKHAM ST
Provider Second Line Business Mailing Address:
S-304 SHOREY BUILDING
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-688-9417
Provider Business Mailing Address Fax Number:
501-257-5796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 MARHAM AVENUE
Provider Second Line Business Practice Location Address:
S-304 SHOREY BUILDING
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-603-1267
Provider Business Practice Location Address Fax Number:
501-257-5796
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  K1155 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: E5214 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 164042001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118811201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200103240A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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