Healthcare Provider Details

I. General information

NPI: 1215138714
Provider Name (Legal Business Name): ANTHONY TAM PHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TAM HUU PHAM D.O.

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 KERMIER RD
WALLER TX
77484-8743
US

IV. Provider business mailing address

6800 BUFFALO SPEEDWAY
HOUSTON TX
77025-1405
US

V. Phone/Fax

Practice location:
  • Phone: 281-818-5333
  • Fax:
Mailing address:
  • Phone: 281-818-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO.000032
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM8917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: