Provider Demographics
NPI:1740207752
Name:PHAM, FRANCIS T (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:T
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 SW 16TH ST RM 2232
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1128
Mailing Address - Country:US
Mailing Address - Phone:352-733-0485
Mailing Address - Fax:352-265-8077
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88708207L00000X
FLME96994207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A887080Medicaid
DC7171580OtherAETNA NON HMO
MD002004400Medicaid
DC242840OtherKAISER
DC3570718OtherAETNA HMO
DC666686OtherNCPPO
VA010108926Medicaid
DC035983800Medicaid
DC015717W13Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE
DC7171580OtherAETNA NON HMO
CA00A887080Medicare PIN
DC035983800Medicaid