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NPI Code Detail

MEDICARE: MARIAN H PHAM MD

MEDICARE: MARIAN H PHAM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician5786141-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285667980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAN H PHAM MD
Provider Business Mailing Address
First Line : 26 S MAIN ST
Second Line :
City : CENTERVILLE
State : UT
Zip : 84014-1817
Country : US
Telephone Number : 801-693-7900
Fax Number : 801-693-7927
Provider Business Practice Location Address
First Line : 26 S MAIN ST
Second Line :
City : CENTERVILLE
State : UT
Zip : 84014-1817
Country : US
Telephone Number : 801-693-7900
Fax Number : 801-693-7927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 09/08/2021

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