Provider Demographics
NPI:1538323639
Name:DANIEL HA PHAM, MD PA
Entity Type:Organization
Organization Name:DANIEL HA PHAM, MD PA
Other - Org Name:DP FAMILY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HA
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-421-2714
Mailing Address - Street 1:3105 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3891
Mailing Address - Country:US
Mailing Address - Phone:817-421-2714
Mailing Address - Fax:817-421-2717
Practice Address - Street 1:3105 IRA E WOODS AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3891
Practice Address - Country:US
Practice Address - Phone:817-421-2714
Practice Address - Fax:817-421-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty