Provider Demographics
NPI:1144222647
Name:PHAM, HENRY THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:THANH
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 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 141
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:281-494-8333
Mailing Address - Fax:281-494-8334
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 141
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-494-8333
Practice Address - Fax:281-494-8334
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-08-29
Deactivation Date:2006-04-06
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TXK2366208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029906701Medicaid
TX5508471OtherAETNA
TX0025BEOtherBCBS
TXG43671Medicare UPIN
TX0025BEMedicare ID - Type Unspecified