Individual
ETHAN MATTHEW FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4402
(214) 345-6176
(214) 345-5167
Mailing address
1140 PEACOCK BLVD, CARROLLTON, TX 75007-2943
(469) 471-4848
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
W0570
TX
Other
Enumeration date
04/14/2022
Last updated
12/09/2025
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