Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2010-00375 | NC |
N | 207V00000X | Obstetrician & Gynecologist | 5101017157 | MI |
NPI | 1003013756 |
---|---|
Provider Name | Mr. Andy Phung |
First Address | High Point, NC 27262-4303 |
Second Address | High Point, NC 27262-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 21/01/2021 |