Mallory, Matthew Layne
Mallory, Matthew Layne is an individual health care provider with primary practice located at 60 E Monte Painter Dr , Fayetteville AR 72703-4014. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Radiation Oncology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Radiation Oncology is his primary health care specialty. Mallory, Matthew Layne can be contacted via phone (479) 587-1700.Contact Information
Primary practice address
60 E Monte Painter Dr
Fayetteville AR 72703-4014
Phone: (479) 587-1700
Fax: (479) 587-1366
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | 0442072 | Kansas |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | E-14474 | Arkansas |
Profile Details
| NPI number | 1194145532 |
|---|---|
| LBN Legal business name | Mallory, Matthew Layne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 24th, 2014 |
| Last updated | Apr 5th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194145532 | NPPES |
| Oklahoma | MEDICAID | 200993230A | |
| Oklahoma | MEDICAID | 269386001 |
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