Healthcare Provider Details

I. General information

NPI: 1336244466
Provider Name (Legal Business Name): BORIAN BORIS MATINCHEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HALSTED CIR SUITE 1
ROGERS AR
72756-3185
US

IV. Provider business mailing address

5 HALSTED CIR SUITE 1
ROGERS AR
72756-3185
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-9002
  • Fax: 479-246-9005
Mailing address:
  • Phone: 479-246-9002
  • Fax: 479-246-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE-2119
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: