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1356430870
LY T PHAN
COLUMBIA, MO
NPI
1356430870
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208600000X Surgery
(Licence: MO 2005030724)
Enumeration Date
2006-10-12
Last Update Date
2017-04-11
Business Address
LY T PHAN MD
1601 E BROADWAY STE 240
COLUMBIA, MO 65201-8020
Phone number: 573-815-8145
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Mailing Address
LY T PHAN MD
670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS, MO 63141-8573
Phone number: 573-815-8145
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