Organization
ELLEN FAN M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN FAN M.D. (PHYSICIAN)
(972) 769-8572
Entity
Organization
Contact information
Practice address
8240 MANDERVILLE LN, DALLAS, TX 75231-1104
(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
—
179654201
—
TX
Enumeration date
06/05/2013
Last updated
05/29/2025
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