Individual provider · Type 1 NPI
Stacey Thao Phan, DO
General Practice Physician · Normal, IL
NPI number
1235263385
Active
Practice location
1300 Franklin Ave Ste 100
Normal, IL 61761-3676
Fax (309) 268-5620
Mailing address
6801 Green Meadow Ln
Oklahoma City, OK 73132-3957
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| General Practice Physician Primary | 208D00000X | None listed |
General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
2 other providers at this address
About NPI 1235263385
Stacey Thao Phan, DO's National Provider Identifier is 1235263385, issued on Mar 14, 2007. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Normal, IL. The record was last updated on Jul 8, 2007.