Healthcare Provider Details

I. General information

NPI: 1033418892
Provider Name (Legal Business Name): TREVOR PHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAMS AVE
FALLON NV
89406-3052
US

IV. Provider business mailing address

PO BOX 17976
RENO NV
89511-1034
US

V. Phone/Fax

Practice location:
  • Phone: 775-530-5886
  • Fax: 702-453-5741
Mailing address:
  • Phone: 775-530-5886
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12765
License Number StateNV

VIII. Authorized Official

Name: TREVOR PHAN
Title or Position: OWNER
Credential: MD
Phone: 775-530-5886