Provider Demographics
NPI:1881837094
Name:PHAM, LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:PHAM
Other - Last Name:MENZIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4429 OVERTON TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C239
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-4868
Practice Address - Fax:972-566-4867
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5942207QS0010X, 2083P0011X, 2083P0011X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine