Individual
DR. BAO LONG PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 MUNICIPAL DR, SUITE 104, RICHARDSON, TX 75080-3651
(972) 671-6398
(972) 235-6419
Mailing address
330 MUNICIPAL DR, SUITE 104, RICHARDSON, TX 75080-3651
(972) 671-6398
(972) 235-6419
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
13456
HI
208200000X
Plastic Surgery Physician
A61602
CA
208200000X
Plastic Surgery Physician
Primary
L4198
TX
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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