Individual
DR. CHARLES GIA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16659 SOUTHWEST FWY, SUITE 175, SUGAR LAND, TX 77479-2375
(281) 277-2213
(281) 277-0192
Mailing address
16659 SOUTHWEST FWY, SUITE 175, SUGAR LAND, TX 77479-2375
(281) 277-2213
(281) 277-0192
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
L6141
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0080JV
BLUECROSS& SHIELD GROUP
—
05
—
1597890
—
TX
05
—
1597908
—
TX
01
—
423947ZP6A
MEDICARE PTAN
TX
01
—
8H8450
BLUECROSS&SHIELD INDIVIDU
—
Enumeration date
05/16/2006
Last updated
08/05/2015
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