Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | C3364 | AR |
NPI | 1619947470 |
---|---|
Provider Name | Dr. Joseph William Matthews |
First Address | Little Rock, AR 72211-1834 |
Second Address | Little Rock, AR 72211-1834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 17/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104356001 | (05) | AR |
D16980 | (02) | AR |