Provider Demographics
NPI:1598766172
Name:PHO, HOAN Q (MD)
Entity Type:Individual
Prefix:
First Name:HOAN
Middle Name:Q
Last Name:PHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10007 HUEBNER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1646
Mailing Address - Country:US
Mailing Address - Phone:210-541-4164
Mailing Address - Fax:210-541-4168
Practice Address - Street 1:10007 HUEBNER RD
Practice Address - Street 2:STE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1646
Practice Address - Country:US
Practice Address - Phone:210-541-4164
Practice Address - Fax:210-541-4168
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ 7359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXO46107101 TXMedicaid
110231814OtherRAILROAD MEDICARE
110231814OtherRAILROAD MEDICARE
87T464Medicare ID - Type Unspecified