Provider Demographics
NPI:1851701429
Name:PHAM, NGOC HAN THI (DPM)
Entity Type:Individual
Prefix:DR
First Name:NGOC HAN
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20461 S TAMIAMI TRL STE 18
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8103
Mailing Address - Country:US
Mailing Address - Phone:305-586-8502
Mailing Address - Fax:239-323-9933
Practice Address - Street 1:20461 S TAMIAMI TRL STE 18
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8103
Practice Address - Country:US
Practice Address - Phone:305-586-8502
Practice Address - Fax:239-323-9933
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3630213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist