Healthcare Provider Details

I. General information

NPI: 1467495101
Provider Name (Legal Business Name): MATTHEW KEMP KAGY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTH UNIVERSITY AVE SUITE 301
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

500 SOUTH UNIVERSITY AVE #301
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4161
  • Fax: 501-664-6108
Mailing address:
  • Phone: 501-664-4161
  • Fax: 501-664-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE1973
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: