Provider Demographics
NPI:1740596188
Name:PHAM, ROBERT (PHD MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:848 N RAINBOW BLVD
Mailing Address - Street 2:#2531
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:702-942-7344
Mailing Address - Fax:954-543-7183
Practice Address - Street 1:848 N RAINBOW BLVD
Practice Address - Street 2:#2531
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1103
Practice Address - Country:US
Practice Address - Phone:702-942-7344
Practice Address - Fax:954-543-7183
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1010026780207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1010026780OtherNEVADA LICENSE