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General NPI Number Information
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NPI Number | 1093920944
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Entity Type | Organization
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Legal Business Name | CUONG TAN DOAN
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 557 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 800-409-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 172 DEER RUN DR
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City | TROUTMAN
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State | NC
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Zip | 28166-7653
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Country | US
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Telephone | 800-409-2919
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Fax |
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Authorized Official
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Title or Position | OWBER
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Name | CUONG TAN DOAN
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Credential | M.D.
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Telephone | 800-409-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NC
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