Provider Demographics
NPI:1699932319
Name:HORINE, LYNDELL C (MD)
Entity type:Individual
Prefix:
First Name:LYNDELL
Middle Name:C
Last Name:HORINE
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 1:3333 PINNACLE HILLS PKWY STE 300-B
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9100
Mailing Address - Country:US
Mailing Address - Phone:479-338-4600
Mailing Address - Fax:479-338-4607
Practice Address - Street 1:3333 PINNACLE HILLS PKWY STE 300-B
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9100
Practice Address - Country:US
Practice Address - Phone:479-338-4600
Practice Address - Fax:479-338-4607
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6775207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188851001Medicaid
AR188851001Medicaid