Provider Demographics
NPI:1063547446
Name:JONATHAN L. HOYT, MD, PA
Entity type:Organization
Organization Name:JONATHAN L. HOYT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-642-5600
Mailing Address - Street 1:145 HIGHWAY 71 N
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-3706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3706
Practice Address - Country:US
Practice Address - Phone:870-642-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146617002Medicaid
AR5C668OtherBCBS
AR146617002Medicaid
ARD04450Medicare UPIN