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Organization
360 MEDICAL PA
Active
Organization
360 MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAN T PHAN DO (PRESIDENT)
(954) 790-2251
Entity
Organization
Contact information
Practice address
2004 NE 49TH ST, FORT LAUDERDALE, FL 33308-4524
(954) 790-2251
(954) 206-2200
Mailing address
2004 NE 49TH ST, FORT LAUDERDALE, FL 33308-4524
(954) 790-2251
(954) 206-2200
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
OS7637
FL
Other
Enumeration date
07/14/2009
Last updated
08/04/2009
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