Basic Information
| Provider Information | |||||||||
| NPI: | 1780718791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAU | ||||||||
| FirstName: | I-FAN | ||||||||
| MiddleName: | THEODORE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | DEPT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907201 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | DEPT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146458898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 11/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | A84366 | CA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 42023 | TN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | M8817 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.