Provider Demographics
NPI:1851360234
Name:PHAM, XUAN-DAO THI (MD)
Entity Type:Individual
Prefix:DR
First Name:XUAN-DAO
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-933-9110
Mailing Address - Fax:205-930-1156
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-933-9110
Practice Address - Fax:205-930-1156
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-66059OtherBLUE CROSS BLUE SHIELD
AL1508887480OtherMEDICARE GROUP PAYEE NPI
ALG591OtherMEDICARE GROUP PAYEE PIN
AL051081251OtherBLUE SHIELD
AL303729106Medicaid
AL113218Medicaid
AL000081251Medicare PIN
ALC72699Medicare UPIN