Provider Demographics
NPI:1902079171
Name:JOSEPHINE THAN WIN, M.D.P.A.
Entity type:Organization
Organization Name:JOSEPHINE THAN WIN, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:THAN
Authorized Official - Last Name:WIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-680-9983
Mailing Address - Street 1:2097 N COLLINS BLVD STE 198
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2684
Mailing Address - Country:US
Mailing Address - Phone:972-680-9983
Mailing Address - Fax:972-680-9163
Practice Address - Street 1:2097 N COLLINS BLVD STE 198
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2684
Practice Address - Country:US
Practice Address - Phone:972-680-9983
Practice Address - Fax:972-680-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100201602Medicaid
TX100201602Medicaid