Provider Demographics
NPI:1033125968
Name:PHAM, ANNE PHUONG (DO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:PHUONG
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 N PINE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-4817
Mailing Address - Country:US
Mailing Address - Phone:407-445-0790
Mailing Address - Fax:407-440-2833
Practice Address - Street 1:1302 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4817
Practice Address - Country:US
Practice Address - Phone:407-445-0790
Practice Address - Fax:407-440-2833
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254958100Medicaid
FLG77978Medicare UPIN
FL254958100Medicaid