Provider Demographics
NPI:1609808864
Name:PHAN, THINH PHU (MD)
Entity Type:Individual
Prefix:
First Name:THINH
Middle Name:PHU
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:PO BOX 8399
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8399
Mailing Address - Country:US
Mailing Address - Phone:281-364-1707
Mailing Address - Fax:281-364-0028
Practice Address - Street 1:25511 BUDDE RD STE 1201
Practice Address - Street 2:BELLE BUILDING
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2091
Practice Address - Country:US
Practice Address - Phone:281-364-1707
Practice Address - Fax:281-364-0028
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA804132085R0001X
TXM44442085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1590473-01OtherGROUP MEDICAID
TX1590648-01OtherGROUP MEDICAID
TX1871594424OtherGROUP NPI
TX00250TOtherGROUP MEDICARE PTAN
TX00251TOtherGROUP MEDICARE PTAN
1700017449OtherGROUP NPI
1477553477OtherGROUP NPI
1487887667OtherGROUP NPI
TX8J7269Medicare PIN
TX1590648-01OtherGROUP MEDICAID
1700017449OtherGROUP NPI
TX1871594424OtherGROUP NPI
1487887667OtherGROUP NPI
TX1590473-01OtherGROUP MEDICAID