Provider Demographics
NPI:1821080995
Name:PHO, LUAN Q (MD)
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:Q
Last Name:PHO
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 1:1105 N CENTRAL EXPWY
Mailing Address - Street 2:MOB 1 SUITE 260
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1105 N CENTRAL EXPWY #260
Practice Address - Street 2:PRESBYTERIAN MED CTR
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6104
Practice Address - Country:US
Practice Address - Phone:972-747-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130894204Medicaid
TX130894204Medicaid
TXG33597Medicare UPIN