Provider Demographics
NPI:1861020240
Name:BALTZ, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BALTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0707
Mailing Address - Country:US
Mailing Address - Phone:870-424-7070
Mailing Address - Fax:870-425-6616
Practice Address - Street 1:675 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3207
Practice Address - Country:US
Practice Address - Phone:870-508-7600
Practice Address - Fax:870-508-7609
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine