Provider Demographics
NPI:1710952734
Name:PHAM, LANHUONG THI (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANHUONG
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2138
Mailing Address - Country:US
Mailing Address - Phone:903-885-2754
Mailing Address - Fax:903-347-1207
Practice Address - Street 1:719 W COKE RD STE 4
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3060
Practice Address - Country:US
Practice Address - Phone:903-347-1201
Practice Address - Fax:309-347-1207
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1633213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158715602Medicaid
TX00363ZMedicare PIN