Provider Demographics
NPI:1457348427
Name:PHAN, DOANH K (MDPA)
Entity Type:Individual
Prefix:DR
First Name:DOANH
Middle Name:K
Last Name:PHAN
Suffix:
Gender:F
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6610
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-6610
Mailing Address - Country:US
Mailing Address - Phone:806-796-0507
Mailing Address - Fax:806-799-6908
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-4212
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E-81287Medicare UPIN
00QK16Medicare ID - Type Unspecified