Healthcare Provider Details

I. General information

NPI: 1427253012
Provider Name (Legal Business Name): VIVIEN DOAN PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N LAKEMONT AVE
WINTER PARK FL
32792-3214
US

IV. Provider business mailing address

1722 LOGANWOOD DR
SAN ANGELO TX
76904-9571
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-6618
  • Fax:
Mailing address:
  • Phone: 325-651-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 100800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: