MEDICARE: MR. TWAN PHANIJPHAND D.O.

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	207RG0100X	Gastroenterology Physician	OS16137	FL
2	207RG0100X	Gastroenterology Physician	5101015350	MI
3	207RG0100X	Gastroenterology Physician	2010014123	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	156440050	OTHER	MO	MEDICARE PTAN #

Other Identifiers

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

General Provider Information

NPI Number	:	1790806248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TWAN PHANIJPHAND D.O.

Provider Business Mailing Address
First Line	:	1326 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1139
Country	:	US
Telephone Number	:	850-601-8177
Fax Number	:	850-862-0605

Provider Business Practice Location Address
First Line	:	1326 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1139
Country	:	US
Telephone Number	:	850-601-8177
Fax Number	:	850-862-0605

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/22/2025

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Directions to “ MR. TWAN PHANIJPHAND D.O.” Practice Location

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