Thuc Duy Phan, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

269123 Issued in NY

Practice address

28 William St
Gouverneur, NY 13642-1405

Phone

(315) 287-2811

NPI assigned

Mar 31, 2011

Last updated

Nov 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Lawrence Psychiatric Center

  • Community/Behavioral Health Agency
  • Gouverneur, NY
  • NPI 1669811881
  NPD (past)
• St. Lawrence Psychiatric Center

  • Community/Behavioral Health Agency
  • Gouverneur, NY
  • NPI 1780135749
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1205125291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 ROZELLE AVE",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774983080",
            "telephone_number": "281-772-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 WILLIAM ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421405",
            "telephone_number": "315-287-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "THUC",
        "middle_name": "DUY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-31",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "R0297",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "269123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Sue Parker
• Tonya L Patton, LPN
• Aimee K Pecori, OD
• Catherine Marie Perrigo, PHARM.D.
• Emily Marie Petrus, LCSW-R
• Elizabeth Pharoah, PHARMD
• Doris M Platt, RN
• Proact Pharmacy Services, Inc.
• Rachel I. Raven Family Health Nurse Practitioner, PLLC
• Rachel I Raven, FNP-C

• Child & Adolescent Psychiatry Physician in Gouverneur, NY
• Providers in Gouverneur, NY by specialty
• Child & Adolescent Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.