Provider Demographics
NPI:1407030737
Name:PHAM, HOAI DUC (MD)
Entity Type:Individual
Prefix:DR
First Name:HOAI
Middle Name:DUC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8681 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-209-8071
Mailing Address - Fax:651-209-8077
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-209-8077
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2024-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN53966207L00000X
WI82615207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100015387Medicaid