Provider Demographics
NPI:1881659381
Name:PHAM, CHAU N (DO)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:N
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 WHITLEY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2493
Mailing Address - Country:US
Mailing Address - Phone:817-479-1181
Mailing Address - Fax:817-918-4432
Practice Address - Street 1:8325 WHITLEY RD
Practice Address - Street 2:SUITE: 100
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2487
Practice Address - Country:US
Practice Address - Phone:817-479-1181
Practice Address - Fax:817-918-4432
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0508207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00480556OtherMEDICARE RAILROAD
TX043666901Medicaid
TXDH2407OtherMEDICARE RAILROAD
P00480556OtherMEDICARE RAILROAD
TX8F6634Medicare PIN