Provider Demographics
NPI:1760678718
Name:TAYLOR, MATTHEW A (AUD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3654
Mailing Address - Country:US
Mailing Address - Phone:870-424-4600
Mailing Address - Fax:870-424-6950
Practice Address - Street 1:202 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3654
Practice Address - Country:US
Practice Address - Phone:870-424-4600
Practice Address - Fax:870-424-6950
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR181231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159922720Medicaid
AR5F337OtherMEDICARE BCBS GRP
AR159922720Medicaid