Healthcare Provider Details

I. General information

NPI: 1861495657
Provider Name (Legal Business Name): DINH QUOC PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 E COMMERCIAL BLVD STE 3
FORT LAUDERDALE FL
33308-3747
US

IV. Provider business mailing address

2098 NE 54TH ST
FORT LAUDERDALE FL
33308-3158
US

V. Phone/Fax

Practice location:
  • Phone: 954-938-8998
  • Fax: 954-901-2838
Mailing address:
  • Phone: 954-938-8998
  • Fax: 954-281-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME82117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: