Provider Demographics
NPI:1548452485
Name:MATOS, HIPOLITO D (MD)
Entity type:Individual
Prefix:DR
First Name:HIPOLITO
Middle Name:D
Last Name:MATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SOUTHRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8063
Mailing Address - Country:US
Mailing Address - Phone:870-494-4200
Mailing Address - Fax:870-494-4482
Practice Address - Street 1:1301 DALE BUMPERS DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2696
Practice Address - Country:US
Practice Address - Phone:870-494-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15242208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice