Provider Demographics
NPI:1245289495
Name:INTHANOUSAY, POHN PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:POHN
Middle Name:PAUL
Last Name:INTHANOUSAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4401 LITTLE RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5624
Mailing Address - Country:US
Mailing Address - Phone:817-572-9890
Mailing Address - Fax:817-572-9887
Practice Address - Street 1:4401 LITTLE RD
Practice Address - Street 2:SUITE 520
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5624
Practice Address - Country:US
Practice Address - Phone:817-572-9890
Practice Address - Fax:817-572-9887
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139893530Medicaid
TX00813FMedicare PIN
TX139893530Medicaid