Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.096152 | OH |
NPI | 1003012907 |
---|---|
Provider Name | Dr. Teresa Thuanh Phan |
First Address | Dublin, OH 43016-4259 |
Second Address | Columbus, OH 43215-6101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 20/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3082962 | (05) | OH |