Provider Demographics
NPI:1467495101
Name:KAGY, MATTHEW KEMP (MD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KEMP
Last Name:KAGY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 SOUTH UNIVERSITY AVE
Mailing Address - Street 2:#301
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-664-4161
Mailing Address - Fax:501-664-6108
Practice Address - Street 1:500 SOUTH UNIVERSITY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-664-4161
Practice Address - Fax:501-664-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1973207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology