Provider Demographics
NPI:1043573645
Name:PHAM, TIMMY MINH-TIEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMMY
Middle Name:MINH-TIEN
Last Name:PHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEDICAL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5430
Mailing Address - Country:US
Mailing Address - Phone:979-836-1111
Mailing Address - Fax:979-836-3600
Practice Address - Street 1:601 MEDICAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5430
Practice Address - Country:US
Practice Address - Phone:979-836-1111
Practice Address - Fax:979-836-3600
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2124213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349578001Medicaid