Provider Demographics
NPI:1841463528
Name:RUSTY A. MLHOAN, MD PA
Entity type:Organization
Organization Name:RUSTY A. MLHOAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MLHOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-375-9790
Mailing Address - Street 1:3150 MATLOCK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2992
Mailing Address - Country:US
Mailing Address - Phone:817-375-9790
Mailing Address - Fax:817-375-9791
Practice Address - Street 1:3150 MATLOCK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2992
Practice Address - Country:US
Practice Address - Phone:817-375-9790
Practice Address - Fax:817-375-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1303208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T27SMedicare PIN
TXC19377Medicare UPIN