Provider Demographics
NPI:1871518522
Name:DE BRUYN, VAN H (MD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:H
Last Name:DE BRUYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SPRING VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4494
Mailing Address - Country:US
Mailing Address - Phone:501-399-4212
Mailing Address - Fax:501-868-7551
Practice Address - Street 1:11220 EXECUTIVE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-399-4212
Practice Address - Fax:501-868-7551
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1621207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR89-V554OtherMALP INS
AR133844001Medicaid
AR89-V554OtherMALP INS
AR5K687Medicare ID - Type Unspecified