MEDICARE: DR. NGUYEN PHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L9848	TX

General Provider Information

NPI Number	:	1245266949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGUYEN PHAN M.D.

Provider Business Mailing Address
First Line	:	8515 SPRING CYPRESS RD
Second Line	:	SUITE #108
City	:	SPRING
State	:	TX
Zip	:	77379-3354
Country	:	US
Telephone Number	:	281-376-2200
Fax Number	:	281-376-2205

Provider Business Practice Location Address
First Line	:	8515 SPRING CYPRESS RD
Second Line	:	SUITE 108
City	:	SPRING
State	:	TX
Zip	:	77379-3354
Country	:	US
Telephone Number	:	281-376-2200
Fax Number	:	281-376-2205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	05/21/2012

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