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Contact Information

LAN T PHAN, DO
701 W COCOA BEACH CSWY
COCOA BEACH, FL32931
 Phone: 321-868-5871
 Fax: 321-868-5852
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hospitalist

208M00000X
 

Nephrology

207RN0300X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for LAN T PHAN · (Female)

NPI # 1245497148
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 05/19/2008
Last updated 03/03/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # OS 7637
  • FL License # OS7637
  • FL Medicaid 000828200
  • FL Other 567240 FL MEDICARE
  • FL Other P01711663 FL RR MEDICARE
Hospital affiliation(s)
  • CAPE CANAVERAL HOSPITAL - (Acute Care)
    701 W COCOA BEACH CAUSEWAY
    COCOA BEACH, FL 32932
  • HOLMES REGIONAL MEDICAL CENTER - (Acute Care)
    1350 S HICKORY ST
    MELBOURNE, FL 32901
  • VIERA HOSPITAL - (Acute Care)
    8745 N WICKHAM RD
    MELBOURNE, FL 32940
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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