Healthcare Provider Details

I. General information

NPI: 1154526515
Provider Name (Legal Business Name): YANG XU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 HIGDON FERRY RD SUITE 200
HOT SPRINGS AR
71913-6999
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-2781
  • Fax: 501-623-1774
Mailing address:
  • Phone: 501-623-2781
  • Fax: 501-623-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE6476
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: