Healthcare Provider Details

I. General information

NPI: 1558366500
Provider Name (Legal Business Name): SCOTT PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-2929
  • Fax: 605-328-8429
Mailing address:
  • Phone: 605-328-4540
  • Fax: 605-328-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number5175
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: