Provider Demographics
NPI:1013328434
Name:PHUOC H PHAM MD
Entity Type:Organization
Organization Name:PHUOC H PHAM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:XUAN-TIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-3166
Mailing Address - Street 1:819 N PINE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7234
Mailing Address - Country:US
Mailing Address - Phone:407-299-3166
Mailing Address - Fax:407-299-3172
Practice Address - Street 1:819 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7234
Practice Address - Country:US
Practice Address - Phone:407-299-3166
Practice Address - Fax:407-299-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058604800Medicaid
FL058604800Medicaid