Provider Demographics
NPI:1790806248
Name:PHANIJPHAND, TWAN (DO)
Entity type:Individual
Prefix:MR
First Name:TWAN
Middle Name:
Last Name:PHANIJPHAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 LEWIS TURNER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1139
Mailing Address - Country:US
Mailing Address - Phone:850-601-8177
Mailing Address - Fax:850-862-0605
Practice Address - Street 1:1326 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1139
Practice Address - Country:US
Practice Address - Phone:850-601-8177
Practice Address - Fax:850-862-0605
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16137207RG0100X
MI5101015350207RG0100X
MO2010014123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156440050OtherMEDICARE PTAN #
MOMA1835017Medicare PIN