Provider Demographics
NPI:1073717476
Name:PHAN, HOANG M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:M
Last Name:PHAN
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 1:20110 STONEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4166
Mailing Address - Country:US
Mailing Address - Phone:832-798-7326
Mailing Address - Fax:
Practice Address - Street 1:20110 STONEVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4166
Practice Address - Country:US
Practice Address - Phone:832-798-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6827207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X6783OtherBCBSTX
TX189146701Medicaid
TX1073717476OtherTRICARE
TX1073717476OtherBCBS TX
TX8K0078Medicare PIN
TX1073717476Medicare PIN
TX8X6783OtherBCBSTX