Provider Demographics
NPI:1255740502
Name:PHAM, THOMAS MINH-NGOC (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MINH-NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEDICAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5429
Mailing Address - Country:US
Mailing Address - Phone:979-836-1111
Mailing Address - Fax:979-836-3600
Practice Address - Street 1:601 MEDICAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5430
Practice Address - Country:US
Practice Address - Phone:979-836-1111
Practice Address - Fax:979-836-3600
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2131213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002AAPOtherTX BCBS
TX002AAPOtherTX BCBS