Provider Demographics
NPI:1245419225
Name:PHAM, TONY AI (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:AI
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AI
Other - Middle Name:CHI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2247 GOLDSMITH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1118
Mailing Address - Country:US
Mailing Address - Phone:713-376-3459
Mailing Address - Fax:832-369-7665
Practice Address - Street 1:1315 ST JOSEPH PKWY 1307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8236
Practice Address - Country:US
Practice Address - Phone:713-376-3459
Practice Address - Fax:832-369-7665
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM58832084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173990601Medicaid
TX173990604Medicaid