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Individual

DR. THAI PHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1321 ASHLEYBROOK LN, WINSTON SALEM, NC 27103-2918
(336) 659-9440
(336) 659-9845
Mailing address
1321 ASHLEYBROOK LN, WINSTON SALEM, NC 27103-2918
(336) 659-9440
(336) 659-9845

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
28930
NC
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
28930
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
67433
BCBS
NC
05
8967433
NC
Enumeration date
10/06/2006
Last updated
07/15/2013
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