Provider Demographics
NPI:1619947470
Name:MATTHEWS, JOSEPH WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11614 HURON LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1834
Mailing Address - Country:US
Mailing Address - Phone:501-221-1956
Mailing Address - Fax:501-219-2327
Practice Address - Street 1:11614 HURON LN
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1834
Practice Address - Country:US
Practice Address - Phone:501-221-1956
Practice Address - Fax:501-219-2327
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC3364207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104356001Medicaid
AR104356001Medicaid
ARD16980Medicare UPIN