Healthcare Provider Details

I. General information

NPI: 1689615114
Provider Name (Legal Business Name): ALBERT H QUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE A-311
DALLAS TX
75230-2505
US

IV. Provider business mailing address

7777 FOREST LN SUITE A-311
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7885
  • Fax: 972-566-3919
Mailing address:
  • Phone: 972-566-7885
  • Fax: 972-566-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberJ3880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: