MEDICARE: DR. TRUNG SI PHAM M.D.

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
1	207R00000X	Internal Medicine Physician	J2257	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1780680264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRUNG SI PHAM M.D.

Provider Business Mailing Address
First Line	:	13119 VETERANS MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1903
Country	:	US
Telephone Number	:	281-537-5300
Fax Number	:	281-537-5699

Provider Business Practice Location Address
First Line	:	13119 VETERANS MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1903
Country	:	US
Telephone Number	:	281-537-5300
Fax Number	:	281-537-5699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/29/2008

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