MEDICARE: DONALD PHAM

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	207Q00000X	Family Medicine Physician	DO3143	NV

General Provider Information

NPI Number	:	1902322548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD PHAM

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	615-314-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 W SAHARA AVE STE 36
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3557
Country	:	US
Telephone Number	:	725-433-3364
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	01/23/2023

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Directions to “ DONALD PHAM ” Practice Location

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