Provider Demographics
NPI:1508396011
Name:PHAM, TUYET (MD)
Entity type:Individual
Prefix:DR
First Name:TUYET
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 1:3417 GASTON AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2037
Mailing Address - Country:US
Mailing Address - Phone:469-800-9000
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 1100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2037
Practice Address - Country:US
Practice Address - Phone:469-800-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7533207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120482146Medicaid