Individual
DR. LAN TUYET PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931
(321) 868-5871
(321) 868-5852
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
OS 7637
FL
208M00000X
Hospitalist Physician
Primary
OS7637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000828200
—
FL
01
—
567240
FL MEDICARE
FL
01
—
P01711663
FL RR MEDICARE
FL
Enumeration date
05/19/2008
Last updated
03/03/2020
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