Healthcare Provider Details

I. General information

NPI: 1437380342
Provider Name (Legal Business Name): STANLEY HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY RM 3-407
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

PO BOX 33932
SHREVEPORT LA
71130-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-6404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA117597
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number323556
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: