Healthcare Provider Details

I. General information

NPI: 1881837094
Provider Name (Legal Business Name): LINDA PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LINDA PHAM MENZIES

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE C239
DALLAS TX
75230-2571
US

IV. Provider business mailing address

4429 OVERTON TERRACE CT
FORT WORTH TX
76109-2518
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-4868
  • Fax: 972-566-4867
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN5942
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberN5942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: