Provider Demographics
NPI:1992119770
Name:BALTZ, REBEKAH GRACE (MD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:GRACE
Last Name:BALTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:GRACE
Other - Last Name:BALTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1651 E STEARNS ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6196
Mailing Address - Country:US
Mailing Address - Phone:479-876-8550
Mailing Address - Fax:479-208-4266
Practice Address - Street 1:1651 E STEARNS ST STE 110
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6196
Practice Address - Country:US
Practice Address - Phone:479-876-8550
Practice Address - Fax:479-208-4266
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11420207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-11420OtherMEDICAL LICENSE