Provider Demographics
NPI:1205916905
Name:PAN, DAVID CHARLES (ACSW LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:PAN
Suffix:
Gender:M
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9319 HARVEST TRAIL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5282
Mailing Address - Country:US
Mailing Address - Phone:210-256-7656
Mailing Address - Fax:210-521-9326
Practice Address - Street 1:9319 HARVEST TRAIL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5282
Practice Address - Country:US
Practice Address - Phone:210-256-7656
Practice Address - Fax:210-521-9326
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0146911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00180PMedicare ID - Type Unspecified