Provider Demographics
NPI:1083913479
Name:HOANG, MARY SAWLAI (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SAWLAI
Last Name:HOANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6261 RONALD REAGAN DR STE B19
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2665
Mailing Address - Country:US
Mailing Address - Phone:636-561-3021
Mailing Address - Fax:
Practice Address - Street 1:6261 RONALD REAGAN DR STE B19
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2665
Practice Address - Country:US
Practice Address - Phone:636-561-3021
Practice Address - Fax:636-561-3022
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015010244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine