Provider Demographics
NPI:1376957589
Name:PHAM, QUANG (DO)
Entity type:Individual
Prefix:DR
First Name:QUANG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GASLIGHT MEDICAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3154
Mailing Address - Country:US
Mailing Address - Phone:936-699-3141
Mailing Address - Fax:936-699-3145
Practice Address - Street 1:121 GASLIGHT MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3154
Practice Address - Country:US
Practice Address - Phone:936-699-3141
Practice Address - Fax:936-699-3145
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1223207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty