Provider Demographics
NPI:1073693495
Name:PHAM, HOANG (MD)
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
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:PO BOX 58534
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8534
Mailing Address - Country:US
Mailing Address - Phone:281-616-6017
Mailing Address - Fax:281-947-3037
Practice Address - Street 1:350 N TEXAS AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4959
Practice Address - Country:US
Practice Address - Phone:281-616-6017
Practice Address - Fax:281-947-3037
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL78452086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00476505OtherRAILROAD
TX165539102Medicaid
TXP00476505OtherRAILROAD
TX8F7559Medicare PIN