MEDICARE: DR. LONG BAO HOANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L5769	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00142628	OTHER	TX	RAILROAD MEDICARE PIN

General Provider Information

NPI Number	:	1649247842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LONG BAO HOANG M.D.

Provider Business Mailing Address
First Line	:	12438 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4809
Country	:	US
Telephone Number	:	281-897-8886
Fax Number	:	281-897-8861

Provider Business Practice Location Address
First Line	:	12438 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4809
Country	:	US
Telephone Number	:	281-897-8886
Fax Number	:	281-897-8861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	03/19/2009

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Directions to “ DR. LONG BAO HOANG M.D.” Practice Location

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