Provider Demographics
NPI:1558850990
Name:PHAM, MAI (DPM)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:909 MOORHEAD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-1357
Mailing Address - Country:US
Mailing Address - Phone:817-697-4840
Mailing Address - Fax:
Practice Address - Street 1:705 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6913
Practice Address - Country:US
Practice Address - Phone:817-697-4840
Practice Address - Fax:817-753-8985
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3082213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery