Healthcare Provider Details

I. General information

NPI: 1326053976
Provider Name (Legal Business Name): PAUL SON DOAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W PERIMETER RD
ANDREWS AFB MD
20762-6604
US

IV. Provider business mailing address

1500 W PERIMETER RD
ANDREWS AFB MD
20762-6604
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-4530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberM
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberM
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: