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NPI Code Detail

MEDICARE: NANCY PHAN MD

MEDICARE:   NANCY  PHAN  MD
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
1208M00000XHospitalist Physician68012AZ
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine PhysicianT0600TX

General Provider Information

NPI Number : 1144727850
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY PHAN MD
Provider Business Mailing Address
First Line : 5920 FOREST PARK RD STE 600
Second Line :
City : DALLAS
State : TX
Zip : 75235-6416
Country : US
Telephone Number : 214-266-0312
Fax Number :
Provider Business Practice Location Address
First Line : 5200 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75235-7709
Country : US
Telephone Number : 214-648-8219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 11/22/2022

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