Healthcare Provider Details

I. General information

NPI: 1447785670
Provider Name (Legal Business Name): TUAN ANH PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BOISE CIR STE 160
BROKEN ARROW OK
74012-4932
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-9160
  • Fax: 918-403-6306
Mailing address:
  • Phone: 918-403-7089
  • Fax: 918-744-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number33096
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: