Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | K1278 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | K1278 | TX |
NPI | 1205948296 |
---|---|
Provider Name | Dr. Vincent C Phan |
First Address | Sugar Land, TX 77479-4728 |
Second Address | Sugar Land, TX 77479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144768201 | (05) | TX |
144768202 | (05) | TX |
144768203 | (05) | TX |
144768204 | (05) | TX |
144768205 | (05) | TX |
144768206 | (05) | TX |
144768207 | (05) | TX |
2630736 | AETNA (01) | TX |
610119705 | US DEPT OF LABOR (01) | TX |
8BP174 | BLUE CROSS BLUE SHIELD (01) | TX |
H34734 | (02) | |
P00732726 | RAILROAD MEDICARE (01) | TX |
P01055722 | RR MEDICARE (01) | TX |