Provider Demographics
NPI:1104386853
Name:PHAM, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
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 1:683 DOUGLAS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2555
Mailing Address - Country:US
Mailing Address - Phone:407-478-1510
Mailing Address - Fax:407-478-1512
Practice Address - Street 1:683 DOUGLAS AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2555
Practice Address - Country:US
Practice Address - Phone:407-478-1510
Practice Address - Fax:407-478-1512
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0071207R00000X
FLME166357207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine