Provider Demographics
NPI:1033283965
Name:PHAM, BICH-NGOC THI (MD)
Entity Type:Individual
Prefix:DR
First Name:BICH-NGOC
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11041 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2628
Mailing Address - Country:US
Mailing Address - Phone:813-749-0844
Mailing Address - Fax:813-749-0846
Practice Address - Street 1:11041 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2628
Practice Address - Country:US
Practice Address - Phone:813-749-0844
Practice Address - Fax:813-749-0846
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101516207Q00000X
FLME101516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine