Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ly T Phan, MD

Individual provider Surgery Physician · NPI 1356430870

Ly T Phan, MD is a General Surgery in Columbia, Missouri. Qualified in 1999, 27 years ago. Practices with Cameron Regional Medical Center Inc, a 67-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
27
Licensed in
MO
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1601 E Broadway Ste 240
Columbia, MO 65201-8020
Phone: (573) 815-8145
Fax: (573) 815-3832
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 2005030724 (MO)

Record details

NPI number1356430870
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 12, 2006
Last updated in NPPESApril 11, 2017
Mailing address670 Mason Ridge Center Dr, Ste 300, Saint Louis, MO 63141-8573

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Cameron Regional Medical Center Inc — 67 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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