Provider Demographics
NPI:1275574683
Name:PHAM, LOAN THU (MD)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:THU
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 E LOWRY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:888-992-2464
Mailing Address - Fax:
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:720-974-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27409074Medicaid
COC806007Medicare PIN
H53494Medicare UPIN