Provider Demographics
NPI:1154602829
Name:VU, ELIZABETH PHAN (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PHAN
Last Name:VU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:214-506-1170
Practice Address - Street 1:6701 HERITAGE PKWY STE 165
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8700
Practice Address - Country:US
Practice Address - Phone:729-792-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0513207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
75-2530206OtherFAMILY HEALTHCARE ASSOCIATES