MEDICARE: CUONG Q PHAN MD

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	174400000X	Specialist	39212	KY
2	174400000X	Specialist
3	2085R0001X	Radiation Oncology Physician	M3691	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00250T	OTHER	TX	GROUP MEDICARE PIN
3	00251T	OTHER	TX	GROUP MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578564241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CUONG Q PHAN MD

Provider Business Mailing Address
First Line	:	25511 BUDDE RD STE 1201
Second Line	:	BELLE BUILDING
City	:	SPRING
State	:	TX
Zip	:	77380-2091
Country	:	US
Telephone Number	:	281-364-1707
Fax Number	:	281-364-0028

Provider Business Practice Location Address
First Line	:	25511 BUDDE RD STE 1201
Second Line	:	BELLE BUILDING
City	:	SPRING
State	:	TX
Zip	:	77380-2091
Country	:	US
Telephone Number	:	281-364-1707
Fax Number	:	281-364-0028

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	09/15/2010

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Directions to “ CUONG Q PHAN MD” Practice Location

Language	Start Address	Practice Location

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