Healthcare Provider Details

I. General information

NPI: 1154702033
Provider Name (Legal Business Name): BRYAN M PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BINZ ST STE 690
HOUSTON TX
77004-6943
US

IV. Provider business mailing address

1200 BINZ ST STE 690
HOUSTON TX
77004-6943
US

V. Phone/Fax

Practice location:
  • Phone: 713-366-7831
  • Fax: 713-482-5815
Mailing address:
  • Phone: 346-339-5949
  • Fax: 713-482-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2015018554
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberS7756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: