Provider Demographics
NPI:1629509591
Name:PHAM, RONALD (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
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 1:1100 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2012
Mailing Address - Country:US
Mailing Address - Phone:954-463-5271
Mailing Address - Fax:954-463-1087
Practice Address - Street 1:1100 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2012
Practice Address - Country:US
Practice Address - Phone:954-463-5271
Practice Address - Fax:954-463-1087
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine