Provider Demographics
NPI:1336244466
Name:MATINCHEV, BORIAN BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIAN
Middle Name:BORIS
Last Name:MATINCHEV
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 1:5 HALSTED CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3185
Mailing Address - Country:US
Mailing Address - Phone:479-246-9002
Mailing Address - Fax:479-246-9005
Practice Address - Street 1:5 HALSTED CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3185
Practice Address - Country:US
Practice Address - Phone:479-246-9002
Practice Address - Fax:479-246-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH03256Medicare UPIN
AR5L264Medicare ID - Type Unspecified