Provider Demographics
NPI:1336141191
Name:VU, PHANN D (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHANN
Middle Name:D
Last Name:VU
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3629
Mailing Address - Country:US
Mailing Address - Phone:636-695-4343
Mailing Address - Fax:636-695-4344
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:STE 280
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3629
Practice Address - Country:US
Practice Address - Phone:636-695-4343
Practice Address - Fax:636-695-4344
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-10-20
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Provider Licenses
StateLicense IDTaxonomies
MO2000151902213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU81166Medicare UPIN