Provider Demographics
NPI:1053438846
Name:HA, JOHN KHOA (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KHOA
Last Name:HA
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 1:6 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3163
Mailing Address - Country:US
Mailing Address - Phone:936-634-0526
Mailing Address - Fax:936-634-0529
Practice Address - Street 1:6 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-634-0526
Practice Address - Fax:936-634-0529
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0196359OtherCIGNA
3867005OtherPRONET
86930FOtherBLUECROSS BLUESHIELD
0196359OtherCIGNA
3867005OtherPRONET