Provider Demographics
NPI:1093035610
Name:PHAN, MIMI (MD)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13219 DOTSON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4308
Mailing Address - Country:US
Mailing Address - Phone:281-955-0338
Mailing Address - Fax:281-469-0741
Practice Address - Street 1:13219 DOTSON RD STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4308
Practice Address - Country:US
Practice Address - Phone:281-955-0338
Practice Address - Fax:281-469-0741
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10038072207R00000X
TXP7537207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine