Healthcare Provider Details

I. General information

NPI: 1093920944
Provider Name (Legal Business Name): CUONG TAN DOAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 BROOKDALE DR
STATESVILLE NC
28677-4107
US

IV. Provider business mailing address

172 DEER RUN DR
TROUTMAN NC
28166-7653
US

V. Phone/Fax

Practice location:
  • Phone: 800-409-2919
  • Fax:
Mailing address:
  • Phone: 800-409-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: CUONG TAN DOAN
Title or Position: OWBER
Credential: M.D.
Phone: 800-409-2919