Provider Demographics
NPI:1093920944
Name:CUONG TAN DOAN
Entity Type:Organization
Organization Name:CUONG TAN DOAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWBER
Authorized Official - Prefix:
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-409-2919
Mailing Address - Street 1:172 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-7653
Mailing Address - Country:US
Mailing Address - Phone:800-409-2919
Mailing Address - Fax:
Practice Address - Street 1:557 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4107
Practice Address - Country:US
Practice Address - Phone:800-409-2919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty