Provider Demographics
NPI:1205948296
Name:PHAN, VINCENT C
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:C
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:281-565-8808
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-565-8808
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1278207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144768206Medicaid
TX2630736OtherAETNA
TX8BP174OtherBLUE CROSS BLUE SHIELD
TX144768202Medicaid
TXP00732726OtherRAILROAD MEDICARE
TX144768204Medicaid
TX144768205Medicaid
TX610119705OtherUS DEPT OF LABOR
TX144768201Medicaid
TXP01055722OtherRR MEDICARE
TX144768203Medicaid
TX144768207Medicaid
TXP01055722OtherRR MEDICARE
TX144768202Medicaid
TX144768201Medicaid
TX81531KMedicare PIN