Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 01057814A | IN |
Y | 207WX0107X | Retina Specialist | 01057814A | IN |
NPI | 1013031756 |
---|---|
Provider Name | Anh-Danh Thi Phan |
First Address | Indianapolis, IN 46202-5133 |
Second Address | Indianapolis, IN 46202-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 17/03/2018 |