Provider Demographics
NPI:1538137369
Name:PHAM, QUEHUONG HT (MD)
Entity Type:Individual
Prefix:DR
First Name:QUEHUONG
Middle Name:HT
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QUEHUONG
Other - Middle Name:HT
Other - Last Name:PHAM-MAST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1406 W 5TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1688
Mailing Address - Country:US
Mailing Address - Phone:606-330-2370
Mailing Address - Fax:352-726-0079
Practice Address - Street 1:1406 W 5TH ST STE 301
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-330-2370
Practice Address - Fax:352-726-0079
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80843208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1538137369OtherNPI
FL259385800Medicaid
FL35762OtherBLUE CROSS BLUE SHIELD
FL35762Medicare PIN