Healthcare Provider Details

I. General information

NPI: 1457814261
Provider Name (Legal Business Name): VIHIEU PHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 LAKE NONA BLVD
ORLANDO FL
32827-7729
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 689-216-8000
  • Fax:
Mailing address:
  • Phone: 904-697-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: