Provider Demographics
NPI:1659682490
Name:HAASE, LOAN THANH PHAM (MD)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:THANH PHAM
Last Name:HAASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOAN
Other - Middle Name:THANH
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6130 N LA CHOLLA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3589
Mailing Address - Country:US
Mailing Address - Phone:520-742-4159
Mailing Address - Fax:
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3589
Practice Address - Country:US
Practice Address - Phone:520-742-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine