Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | E-9922 | AR |
Y | 207RC0200X | Critical Care Medicine | E-9922 | AR |
NPI | 1083957245 |
---|---|
Provider Name | Nhan H Phan |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 08/06/2020 |