Provider Demographics
NPI:1619552841
Name:DOAN, CHANH C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHANH
Middle Name:C
Last Name:DOAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:LAROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70373-5967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:753 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70373-5967
Practice Address - Country:US
Practice Address - Phone:985-601-4839
Practice Address - Fax:985-693-1439
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant