Provider Demographics
NPI:1760677900
Name:PAN, WEIHONG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WEIHONG
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:STE 107
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-649-7991
Mailing Address - Fax:
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 107
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-649-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53451207RS0012X, 2084N0400X
LAMD.13456R207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121769Medicaid
LA5H202Medicare PIN
LA1481050Medicaid
LA4Q2236629Medicare PIN
TN103IC04946Medicare PIN
LA1481050Medicaid