Provider Demographics
NPI:1114919107
Name:HATCH, ALLAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:B
Last Name:HATCH
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 1:1000 HIGHWAY 35 N STE 8
Mailing Address - Street 2:P.O. BOX 2860
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2351
Mailing Address - Country:US
Mailing Address - Phone:501-315-4008
Mailing Address - Fax:501-315-3411
Practice Address - Street 1:1000 HIGHWAY 35 N
Practice Address - Street 2:SUITE 8
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2351
Practice Address - Country:US
Practice Address - Phone:501-315-4008
Practice Address - Fax:501-315-3411
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0963207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1104959410OtherGROUP - NPI
AR129524001Medicaid
AR1104959410OtherGROUP - NPI
AR129524001Medicaid