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General NPI Number Information
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NPI Number | 1689764151
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Entity Type | Individual
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Provider Name | MATTHEW DENEKE MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-4596
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7199
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-4596
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 107008
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 56852
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-4436
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License Number State | AR
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