Provider Demographics
NPI:1457303737
Name:PHAN, CHARLES GIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GIA
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 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:281-277-2213
Mailing Address - Fax:281-277-0192
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 175
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-277-2213
Practice Address - Fax:281-277-0192
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6141207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0080JVOtherBLUECROSS& SHIELD GROUP
TX1597890Medicaid
TX1597908Medicaid
TX423947ZP6AOtherMEDICARE PTAN
8H8450OtherBLUECROSS&SHIELD INDIVIDU
G70891Medicare UPIN
0080JVOtherBLUECROSS& SHIELD GROUP