Provider Demographics
NPI:1356396790
Name:PHAM, THUYLINH (MD)
Entity type:Individual
Prefix:
First Name:THUYLINH
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134686001Medicaid
AR134686001Medicaid
G74524Medicare UPIN