Provider Demographics
NPI:1669857595
Name:PHAN, UYEN NGOC BAO (PA)
Entity Type:Individual
Prefix:MRS
First Name:UYEN
Middle Name:NGOC BAO
Last Name:PHAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:723 N FIELDER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4697
Mailing Address - Country:US
Mailing Address - Phone:817-261-1122
Mailing Address - Fax:817-261-1123
Practice Address - Street 1:2800 E BROAD ST
Practice Address - Street 2:SUITE 124
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6409
Practice Address - Country:US
Practice Address - Phone:817-539-0959
Practice Address - Fax:817-539-0480
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2019-02-11
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant