Provider Demographics
NPI:1225067721
Name:PHAM, HIEU T (DO)
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:T
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
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 5607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5607
Mailing Address - Country:US
Mailing Address - Phone:281-991-2211
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:5010 CRENSHAW RD
Practice Address - Street 2:STE. #130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-991-2211
Practice Address - Fax:281-991-7700
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046CCOtherRPK MEDICARE GROUP #
TXPENDINGMedicaid
TX8K2180OtherMEDICAL INCOME-KATY
TX8L14594Medicare PIN
TX8K2180OtherMEDICAL INCOME-KATY