Fan, Matthew Nan

Fan, Matthew Nan is an individual health care provider with primary practice located at 855 Montgomery St , Fort Worth TX 76107-2553. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Fan, Matthew Nan can be contacted via phone (817) 735-2400.

Contact Information

Primary practice address
855 Montgomery St Fort Worth TX 76107-2553
Phone: (817) 735-2400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 44743 Texas
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 0116025230 Virginia
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 44743 Texas

Profile Details

NPI number 1063777860
LBN Legal business name Fan, Matthew Nan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2012
Last updated Mar 2nd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063777860 NPPES
Texas Other 8ER294 BCBS
Texas MEDICAID 340717301 BCBS

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