Provider Demographics
NPI:1003102617
Name:PHAM, NHAT-LONG LAM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NHAT-LONG
Middle Name:LAM
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 FOX GLN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4318
Mailing Address - Country:US
Mailing Address - Phone:858-309-2995
Mailing Address - Fax:
Practice Address - Street 1:5801 FOREST PARK RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9183
Practice Address - Country:US
Practice Address - Phone:241-645-7615
Practice Address - Fax:214-645-7624
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ86032085R0001X
CAA1260862085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology