Healthcare Provider Details

I. General information

NPI: 1144654831
Provider Name (Legal Business Name): ANHTUAN PHAM MD, MPH, MHA, CAC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WADSWORTH BLVD
LAKEWOOD CO
80214-5256
US

IV. Provider business mailing address

PO BOX 27705
DENVER CO
80227-0705
US

V. Phone/Fax

Practice location:
  • Phone: 303-238-1488
  • Fax:
Mailing address:
  • Phone: 720-308-0195
  • Fax: 303-245-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6852
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: