Healthcare Provider Details

I. General information

NPI: 1437890217
Provider Name (Legal Business Name): MATTHEW CHRISTOPHER FORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 515
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

502 NE LAKE POINTE PL
BENTONVILLE AR
72712-3001
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-1656
  • Fax:
Mailing address:
  • Phone: 479-903-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD21148
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: