Provider Demographics
NPI:1861495657
Name:PHAM, DINH QUOC (MD)
Entity Type:Individual
Prefix:
First Name:DINH
Middle Name:QUOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2098 NE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3158
Mailing Address - Country:US
Mailing Address - Phone:954-938-8998
Mailing Address - Fax:954-281-5408
Practice Address - Street 1:1880 E COMMERCIAL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3747
Practice Address - Country:US
Practice Address - Phone:954-938-8998
Practice Address - Fax:954-901-2838
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82117207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267997300Medicaid
FL110236072Medicare PIN
FLH35931Medicare UPIN