Provider Demographics
NPI:1912189796
Name:CHARLES G. PHAN, M.D. GASTROINTESTINAL & LIVER DISEASE CONSULTANTS,
Entity Type:Organization
Organization Name:CHARLES G. PHAN, M.D. GASTROINTESTINAL & LIVER DISEASE CONSULTANTS,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:NGOCMY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-277-2213
Mailing Address - Street 1:16659 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE #175
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2351
Mailing Address - Country:US
Mailing Address - Phone:281-277-2213
Mailing Address - Fax:281-277-0192
Practice Address - Street 1:16659 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE #175
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2351
Practice Address - Country:US
Practice Address - Phone:281-277-2213
Practice Address - Fax:281-277-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6141207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080JVOtherBLUE CROSS BLUESHIELD
TX159789001Medicaid
TX159789001Medicaid
TX424077Medicare PIN