Healthcare Provider Details

I. General information

NPI: 1134322233
Provider Name (Legal Business Name): NORTHERN PINES HEALTH PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 SPRING CYPRESS RD #108
SPRING TX
77379-3354
US

IV. Provider business mailing address

8515 SPRING CYPRESS RD SUITE #108
SPRING TX
77379-3354
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-2200
  • Fax: 281-376-2205
Mailing address:
  • Phone: 281-376-2200
  • Fax: 281-376-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9848
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM6312
License Number StateTX

VIII. Authorized Official

Name: DR. NGUYEN DUC PHAN
Title or Position: DIRECTOR
Credential: MD
Phone: 281-376-2200