Phan, Thai
Phan, Thai is an sole proprietor health care provider with primary practice located at 1321 Ashleybrook Ln , Winston Salem NC 27103-2918. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Pain Medicine. Other Service Providers / Specialist is his primary health care specialty. Phan, Thai can be contacted via phone (336) 659-9440.Contact Information
Primary practice address
1321 Ashleybrook Ln
Winston Salem NC 27103-2918
Phone: (336) 659-9440
Fax: (336) 659-9845
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 28930 | North Carolina |
| Allopathic & Osteopathic Physicians / Pain Medicine | 2084P2900X | 28930 | North Carolina |
Profile Details
| NPI number | 1326135021 |
|---|---|
| LBN Legal business name | Phan, Thai |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 6th, 2006 |
| Last updated | Jul 15th, 2013 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326135021 | NPPES |
| North Carolina | Other | 67433 | BCBS |
| North Carolina | MEDICAID | 8967433 | BCBS |
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