Provider Demographics
NPI:1568896181
Name:PHAM, HY GIA (DO)
Entity Type:Individual
Prefix:DR
First Name:HY
Middle Name:GIA
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DOUGLAS CIR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4536
Mailing Address - Country:US
Mailing Address - Phone:305-293-4834
Mailing Address - Fax:305-293-4190
Practice Address - Street 1:1300 DOUGLAS CIR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4536
Practice Address - Country:US
Practice Address - Phone:305-293-4834
Practice Address - Fax:305-293-4190
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02004763A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program