Provider Demographics
NPI:1487851358
Name:PHAM, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3648 W ANTHEM WAY
Mailing Address - Street 2:SUITE A100
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-7001
Mailing Address - Country:US
Mailing Address - Phone:623-434-6444
Mailing Address - Fax:623-434-6448
Practice Address - Street 1:3648 W ANTHEM WAY
Practice Address - Street 2:SUITE A100
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-7001
Practice Address - Country:US
Practice Address - Phone:623-434-6444
Practice Address - Fax:623-434-6448
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5273207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139237Medicare PIN