MEDICARE: LOAN DOAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1134860083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOAN DOAN

Provider Business Mailing Address
First Line	:	10906 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10906 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6316
Country	:	US
Telephone Number	:	480-353-2286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/27/2022

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Directions to “ LOAN DOAN ” Practice Location

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