Healthcare Provider Details

I. General information

NPI: 1750352373
Provider Name (Legal Business Name): GABRIEL MATONBA PEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/07/2023
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 720
LITTLE ROCK AR
72205-5345
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 720
LITTLE ROCK AR
72205-5345
US

V. Phone/Fax

Practice location:
  • Phone: 501-558-4900
  • Fax: 501-558-4909
Mailing address:
  • Phone: 501-558-4900
  • Fax: 501-558-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE1660
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberE1660
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: