Healthcare Provider Details

I. General information

NPI: 1497841530
Provider Name (Legal Business Name): RAMON CARLOS YLANAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N PARKVIEW DR
FAYETTEVILLE AR
72703-6398
US

IV. Provider business mailing address

3900 N PARKVIEW DR
FAYETTEVILLE AR
72703-6398
US

V. Phone/Fax

Practice location:
  • Phone: 479-966-4187
  • Fax: 479-966-4197
Mailing address:
  • Phone: 479-966-4187
  • Fax: 479-966-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2004017667
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31290
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number31290
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberE-7389
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: