Individual
ELLEN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3308 PRESTON RD, SUITE 350 BOX 242, PLANO, TX 75093-7453
(972) 769-8572
(972) 769-8591
Mailing address
3308 PRESTON RD, SUITE 350 BOX 242, PLANO, TX 75093-7453
(972) 769-8572
(972) 769-8591
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
K8897
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179655901
—
TX
Enumeration date
07/10/2006
Last updated
06/05/2013
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