Healthcare Provider Details

I. General information

NPI: 1225088842
Provider Name (Legal Business Name): THOMAS ANH PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

IV. Provider business mailing address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

V. Phone/Fax

Practice location:
  • Phone: 303-466-1866
  • Fax: 303-466-4081
Mailing address:
  • Phone: 303-466-4081
  • Fax: 303-466-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0053133
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: