Provider Demographics
NPI:1396963658
Name:KINCADE, MATTHEW C (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:KINCADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3333 S PINNACLE HILLS PKWY STE 300A
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9000
Mailing Address - Country:US
Mailing Address - Phone:479-271-7077
Mailing Address - Fax:479-271-7035
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY STE 300A
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9000
Practice Address - Country:US
Practice Address - Phone:479-271-7077
Practice Address - Fax:479-271-7035
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004671208800000X
ARE-12884208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01159463OtherRR MCR
MO1396963658Medicaid
AR196652001Medicaid
MO431560263OtherTRICARE
MO1396963658Medicaid