Healthcare Provider Details

I. General information

NPI: 1699932319
Provider Name (Legal Business Name): LYNDELL C HORINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 PINNACLE HILLS PKWY STE 300-B
ROGERS AR
72758-9100
US

IV. Provider business mailing address

3333 PINNACLE HILLS PKWY STE 300-B
ROGERS AR
72758-9100
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-4600
  • Fax: 479-338-4607
Mailing address:
  • Phone: 479-338-4600
  • Fax: 479-338-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberE-6775
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: