Provider Demographics
NPI:1487849188
Name:PHAM, DAVID T D (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T D
Last Name:PHAM
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER IM EDU
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3939 US HIGHWAY 80 E STE 458A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-8109
Practice Address - Country:US
Practice Address - Phone:972-289-2273
Practice Address - Fax:972-439-1776
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX922214163WG0000X
GATL2791207R00000X
TX1011822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine