Provider Demographics
NPI:1669786042
Name:PHYO, NYAN WAI (MD)
Entity type:Individual
Prefix:
First Name:NYAN
Middle Name:WAI
Last Name:PHYO
Suffix:
Gender:M
Credentials:MD
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 3247
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3247
Mailing Address - Country:US
Mailing Address - Phone:956-688-6800
Mailing Address - Fax:956-688-6804
Practice Address - Street 1:1900 S JACKSON RD STE 12
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-688-6800
Practice Address - Fax:956-688-6804
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP25318207R00000X
TXQ4249207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351937302OtherMEDICAID-CSHCN
TX351937301Medicaid
TX435418AQ1JOtherMEDICARE