Provider Demographics
NPI:1245754902
Name:TONY A PHAM MD PA
Entity Type:Organization
Organization Name:TONY A PHAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:AI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-341-3111
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1307
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8236
Mailing Address - Country:US
Mailing Address - Phone:713-376-3459
Mailing Address - Fax:713-655-0506
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 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:713-655-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM58832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173990604Medicaid