Provider Demographics
NPI:1659326312
Name:TOTTEN, MATTHEW B (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:TOTTEN
Suffix:
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 1:1607 S OLD MISSOURI RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5723
Mailing Address - Country:US
Mailing Address - Phone:479-463-4887
Mailing Address - Fax:479-463-4886
Practice Address - Street 1:1607 S OLD MISSOURI RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5723
Practice Address - Country:US
Practice Address - Phone:479-463-4887
Practice Address - Fax:479-463-4886
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N335OtherAR BLUE CROSS/BLUE SHIELD
AR158311001Medicaid
ARP00346432OtherRR MCR
ARI40779Medicare UPIN
AR5N3356658Medicare PIN
ARP00346432OtherRR MCR