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NPI Code Detail

MEDICARE: DR. FAN LI M.D.

MEDICARE: DR. FAN LI M.D.
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
1207Q00000XFamily Medicine PhysicianL0378TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659368330
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FAN LI M.D.
Provider Business Mailing Address
First Line : 6807 EMMETT F LOWRY EXPY
Second Line : 103
City : TEXAS CITY
State : TX
Zip : 77591-2546
Country : US
Telephone Number : 409-938-1770
Fax Number : 409-938-0701
Provider Business Practice Location Address
First Line : 6807 EMMETT F LOWRY EXPY
Second Line : 103
City : TEXAS CITY
State : TX
Zip : 77591-2546
Country : US
Telephone Number : 409-938-1770
Fax Number : 409-938-0701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 02/18/2013

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