Provider Demographics
NPI:1891716601
Name:PHAM, MINH D (DO)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:D
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MINH
Other - Middle Name:D
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2615 SOUTHWEST FREEWAY
Mailing Address - Street 2:#140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4609
Mailing Address - Country:US
Mailing Address - Phone:713-441-3724
Mailing Address - Fax:713-838-0887
Practice Address - Street 1:2615 SOUTHWEST FREEWAY
Practice Address - Street 2:#140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4609
Practice Address - Country:US
Practice Address - Phone:713-441-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6401OtherBCBS
TX103707909Medicaid
TX8B7191Medicare PIN
TXP00141048Medicare PIN
TX103707909Medicaid
TXG78047Medicare UPIN