Provider Demographics
NPI:1841491503
Name:PHAM, JOHN-PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN-PAUL
Middle Name:
Last Name:PHAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 GATE PKWY W STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3685
Mailing Address - Country:US
Mailing Address - Phone:904-513-3179
Mailing Address - Fax:904-337-1641
Practice Address - Street 1:8075 GATE PKWY W STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3685
Practice Address - Country:US
Practice Address - Phone:904-513-3179
Practice Address - Fax:904-337-1641
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107417207R00000X, 207RC0000X, 207RI0011X, 207RC0000X
OH35.123904207RI0011X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12815090-15OtherMULTIPLAN
FLHR822AOtherFL MEDICARE - GROUP
FL004XPOtherFLORIDA BLUE - GROUP
FLDU5524OtherRR MEDICARE - GROUP
FL338492OtherAVMED
FLPO1575702OtherRR MEDICARE - INDIVIDUAL
FL024325001Medicaid
GA835289786AMedicaid
FL338492OtherAVMED
FLDI920ZMedicare PIN