Doctor Name: | DR. KELLY MYANH PHAN |
NPI Number: | 1578721940 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | BP10028513 |
Business Practice Address: | Scott And White Hospital 2401 South 31st Street Temple, TX - 765080001 |
Business Phone Number: | 2547242111 |
Business Fax Number: | |
Mailing Address: | 2408 Wilshire Dr, TEMPLE |
State: | TX |
Postal Code: | 765027323 |
Phone Number: | 2812354614 |
Fax Number: | |
NPI Enumeration Date: | 06/01/2008 |
NPI Last Update Date: | 06/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10028513 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |