Healthcare Provider Details

I. General information

NPI: 1467548032
Provider Name (Legal Business Name): LAN P TRAN-PHU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 FOUNTAINHEAD LANE
FAYETTEVILLE NC
28301-5417
US

IV. Provider business mailing address

203 SEDBERRY STREET
FAYETTEVILLE NC
28305-4939
US

V. Phone/Fax

Practice location:
  • Phone: 910-433-3652
  • Fax: 910-433-3701
Mailing address:
  • Phone: 910-483-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97-01176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: