Provider Demographics
NPI:1467448837
Name:HOUCHIN, VONDA GALE (MD)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:GALE
Last Name:HOUCHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 ILLINOIS
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432
Mailing Address - Country:US
Mailing Address - Phone:870-578-5443
Mailing Address - Fax:870-578-9443
Practice Address - Street 1:802 ILLINOIS
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432
Practice Address - Country:US
Practice Address - Phone:870-578-5443
Practice Address - Fax:870-578-9443
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120552001Medicaid
AR120552001Medicaid
AR55005Medicare PIN
AR55005Medicare ID - Type UnspecifiedMEDICARE PROVIDER