Provider Demographics
NPI:1174500979
Name:PHAN, VICTOR VAN (DO)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:VAN
Last Name:PHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11920 ASTORIA BLVD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6097
Mailing Address - Country:US
Mailing Address - Phone:281-922-1800
Mailing Address - Fax:281-922-4050
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 390
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6134
Practice Address - Country:US
Practice Address - Phone:281-922-1800
Practice Address - Fax:281-922-4050
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL3782207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1153OtherMEDICARE GROUP PTAN
TX8F1153OtherMEDICARE GROUP PTAN
H59324Medicare UPIN