Healthcare Provider Details

I. General information

NPI: 1538113469
Provider Name (Legal Business Name): HERBERT A. PHELAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD E5-508
DALLAS TX
75390-9158
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-6841
  • Fax: 214-648-5477
Mailing address:
  • Phone: 214-648-6841
  • Fax: 214-648-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number26277
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number26277
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberL6574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: