Provider Demographics
NPI:1689899601
Name:PHAN, DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
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 1:1475 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3538
Mailing Address - Country:US
Mailing Address - Phone:615-760-6583
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:2680 S VAL VISTA DR STE 132
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2155
Practice Address - Country:US
Practice Address - Phone:480-253-5618
Practice Address - Fax:480-507-5677
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58530207ZP0102X
CAA105477207ZP0102X
TN49316207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN065WOtherMEDICARE PTAN-GEN
CAGN065VOtherMEDICARE PTAN-MEM
CADN065UOtherMEDICARE PTAN-ROSEVILLE
CADN065ZOtherMEDICARE PTAN-DPMG
CA1689899601Medicaid
CADN065SOtherMEDICARE PTAN-AUBURN
CADN065TOtherMEDICARE PTAN-DAVIS
CADN065XOtherMEDICARE PTAN-MERCY
CADN065YOtherMEDICARE PTAN-METH