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NPI Code Detail

MEDICARE: LAN THANH LE DO

MEDICARE: LAN THANH LE DO
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
1208100000XPhysical Medicine & Rehabilitation PhysicianN2163TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10016SVOTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417166240
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAN THANH LE DO
Provider Business Mailing Address
First Line : P O BOX 678610
Second Line :
City : DALLAS
State : TX
Zip : 75267-8610
Country : US
Telephone Number : 817-336-7188
Fax Number : 817-335-9039
Provider Business Practice Location Address
First Line : 5632 EDWARDS RANCH RD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4149
Country : US
Telephone Number : 817-336-7188
Fax Number : 844-231-8865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 10/14/2021

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Directions to “ LAN THANH LE DO” Practice Location

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