Healthcare Provider Details

I. General information

NPI: 1538188057
Provider Name (Legal Business Name): THONG QUOC PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 SUNNYBROOK DR SUITE L-200
SIOUX CITY IA
51106-4203
US

IV. Provider business mailing address

PO BOX 3128
SIOUX CITY IA
51102-3128
US

V. Phone/Fax

Practice location:
  • Phone: 712-239-4702
  • Fax: 712-224-5898
Mailing address:
  • Phone: 712-239-4702
  • Fax: 712-224-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD-37909
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number24761
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36077772
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number36077772
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number36077772
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number36077772
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number7294
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: