Healthcare Provider Details

I. General information

NPI: 1174544415
Provider Name (Legal Business Name): NORTHERN PINES HEALTH PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

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 PHAN
Title or Position: OWNER
Credential: M.D.
Phone: 281-376-2200