Provider Demographics
NPI:1073740387
Name:HOANG, BRYAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:H
Last Name:HOANG
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 1:412 REBECCA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3946
Mailing Address - Country:US
Mailing Address - Phone:870-723-4897
Mailing Address - Fax:870-367-2102
Practice Address - Street 1:113 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2730
Practice Address - Country:US
Practice Address - Phone:870-226-2844
Practice Address - Fax:870-226-5200
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-7410OtherAR MEDICAL BOARD STATE LICENSE #
AR196269001Medicaid
AR196269001Medicaid
ARE-7410OtherAR MEDICAL BOARD STATE LICENSE #
AR196269001Medicaid