Provider Demographics
NPI:1457671729
Name:CANLAS, TEIY BUN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TEIY
Middle Name:BUN
Last Name:CANLAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TEIY
Other - Middle Name:KHENG
Other - Last Name:BUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2808
Mailing Address - Country:US
Mailing Address - Phone:936-760-7828
Mailing Address - Fax:936-521-8206
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-760-7828
Practice Address - Fax:936-521-8206
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06538363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical