Provider Demographics
NPI:1245266949
Name:PHAN, NGUYEN (MD)
Entity type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8515 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3354
Mailing Address - Country:US
Mailing Address - Phone:281-376-2200
Mailing Address - Fax:281-376-2205
Practice Address - Street 1:8515 SPRING CYPRESS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3354
Practice Address - Country:US
Practice Address - Phone:281-376-2200
Practice Address - Fax:281-376-2205
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI18006Medicare UPIN
TX8F3805Medicare PIN