Provider Demographics
NPI:1699762484
Name:BABER, JOHN TYLER SR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:BABER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3108
Mailing Address - Country:US
Mailing Address - Phone:501-666-0249
Mailing Address - Fax:501-666-4340
Practice Address - Street 1:415 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3108
Practice Address - Country:US
Practice Address - Phone:501-666-0249
Practice Address - Fax:501-666-4340
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4911207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0100114958OtherRAILROAD MEDICARE
AR4203424OtherAETNA
AR15139000000OtherQUALCHOICE
AR2920017OtherUNITED HEALTH
AR2920017OtherUNITED HEALTH
AR4203424OtherAETNA
AR50182Medicare ID - Type Unspecified