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General NPI Number Information
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NPI Number | 1528250701
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Entity Type | Individual
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Provider Name | THANH PHAN PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 15950 ELDORADO PKWY STE 400
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City | FRISCO
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State | TX
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Zip | 75035-5802
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Country | US
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Telephone | 214-390-5388
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Fax | 972-547-0513
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Provider Business Mailing Address
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Address Line | 15950 ELDORADO PKWY STE 400
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City | FRISCO
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State | TX
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Zip | 75035-5816
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Country | US
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Telephone | 214-390-5388
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Fax | 972-547-0513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05186
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License Number State | TX
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