Provider Demographics
NPI:1538113469
Name:PHELAN, HERBERT A (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:A
Last Name:PHELAN
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-6841
Mailing Address - Fax:214-648-5477
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:E5-508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9158
Practice Address - Country:US
Practice Address - Phone:214-648-6841
Practice Address - Fax:214-648-5477
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL262772086S0127X, 2086S0102X
TXL65742086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981675Medicaid
AL51526082OtherBLUE CROSS
MS04551295Medicaid
AL76-00405OtherUNITED HEALTH CARE
AL009982245Medicaid
FL272262300Medicaid
AL51526083OtherBLUE CROSS
AL51526082OtherBLUE CROSS
FL272262300Medicaid