Provider Demographics
NPI:1205248259
Name:THUYLINH HO PHAM MD PLLC
Entity type:Organization
Organization Name:THUYLINH HO PHAM MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THUYLINH
Authorized Official - Middle Name:HO
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-441-1500
Mailing Address - Street 1:623 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3914
Mailing Address - Country:US
Mailing Address - Phone:479-441-1500
Mailing Address - Fax:479-441-1502
Practice Address - Street 1:623 S 21ST ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3914
Practice Address - Country:US
Practice Address - Phone:479-441-1500
Practice Address - Fax:479-441-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty