360 Medical PA
Organization Active NPI Nephrology Physician · Fort Lauderdale, FL
NPI 1508096330 · NPPES record last updated Aug 4, 2009
Key facts
- NPI
- 1508096330
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- OS7637 (FL)
- Legal business name
- 360 MEDICAL PA
- Practice address
- 2004 NE 49TH St
Fort Lauderdale, FL 33308-4524 - Phone
- (954) 790-2251
- Fax
- (954) 206-2200
- NPI assigned
- Jul 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Lan T Phan, DO
- Title
- President
- Phone
- (954) 790-2251
National Provider Directory
Locations
4875 NE 20th Ter
Ft Lauderdale, FL 33308
Phone (954) 727-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | OS7637 | FL | Yes |
Addresses
Primary practice location
2004 NE 49TH St
Fort Lauderdale, FL 33308-4524
Mailing address
2004 NE 49TH St
Fort Lauderdale, FL 33308-4524
Phone (954) 790-2251
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.