Provider Demographics
NPI:1497134696
Name:PHAM, BAO Q (MD)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:Q
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 1:15322 COPPER GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2293
Mailing Address - Country:US
Mailing Address - Phone:281-356-1945
Mailing Address - Fax:281-356-1978
Practice Address - Street 1:15322 COPPER GROVE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2293
Practice Address - Country:US
Practice Address - Phone:281-356-1945
Practice Address - Fax:281-356-1978
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-11579207Q00000X
WAMD61131539207Q00000X
390200000X
TXR8461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program