Healthcare Provider Details

I. General information

NPI: 1154412815
Provider Name (Legal Business Name): RHONDA MATTOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

IV. Provider business mailing address

14524 CANTRELL RD
LITTLE ROCK AR
72223-4702
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-4900
  • Fax: 870-534-4906
Mailing address:
  • Phone: 501-240-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE4855
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: