Healthcare Provider Details

I. General information

NPI: 1144664384
Provider Name (Legal Business Name): DR. THANH LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E CENTERTON BLVD
CENTERTON AR
72719-9217
US

IV. Provider business mailing address

614 E EMMA AVE STE 300
SPRINGDALE AR
72764-4469
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-7417
  • Fax: 479-751-4898
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-751-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-9104
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: