MEDICARE: MINH D PHAM D.O.

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	207P00000X	Emergency Medicine Physician	K9870	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F6401	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891716601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH D PHAM D.O.

Provider Business Mailing Address
First Line	:	2615 SOUTHWEST FREEWAY
Second Line	:	#140
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-441-3724
Fax Number	:	713-838-0887

Provider Business Practice Location Address
First Line	:	2615 SOUTHWEST FREEWAY
Second Line	:	#140
City	:	HOUSTON
State	:	TX
Zip	:	77098-4609
Country	:	US
Telephone Number	:	713-441-3724
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/10/2009

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