Provider Demographics
NPI:1619980547
Name:PHAM, NICHOLAS MINH (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2469
Mailing Address - Country:US
Mailing Address - Phone:623-876-9983
Mailing Address - Fax:623-876-9984
Practice Address - Street 1:14239 W BELL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2469
Practice Address - Country:US
Practice Address - Phone:623-876-9983
Practice Address - Fax:623-876-9984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ28681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28681OtherAZ LICENSE