Provider Demographics
NPI:1447785670
Name:PHAM, TUAN ANH (MD)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E 19TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5422
Mailing Address - Country:US
Mailing Address - Phone:918-403-7089
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:4720 S HARVARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3023
Practice Address - Country:US
Practice Address - Phone:918-749-4673
Practice Address - Fax:918-403-6318
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33096207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine