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Individual

CUONG Q PHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
25511 BUDDE RD STE 1201, BELLE BUILDING, SPRING, TX 77380-2091
(281) 364-1707
(281) 364-0028
Mailing address
25511 BUDDE RD STE 1201, BELLE BUILDING, SPRING, TX 77380-2091
(281) 364-1707
(281) 364-0028

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
39212
KY
174400000X
Specialist
2085R0001X
Radiation Oncology Physician
Primary
M3691
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00250T
GROUP MEDICARE PIN
TX
01
00251T
GROUP MEDICARE PIN
TX
01
1590473-01
GROUP MEDICAID
TX
01
1590648-01
GROUP MEDICAID
TX
Enumeration date
08/03/2005
Last updated
09/15/2010
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