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General NPI Number Information
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NPI Number | 1003102617
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Entity Type | Individual
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Provider Name | NHAT-LONG LAM PHAM M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 5801 FOREST PARK RD
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City | DALLAS
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State | TX
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Zip | 75390-9183
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Country | US
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Telephone | 241-645-7615
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Fax | 214-645-7624
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Provider Business Mailing Address
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Address Line | 507 FOX GLN
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City | SOUTHLAKE
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State | TX
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Zip | 76092-4318
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Country | US
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Telephone | 858-309-2995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | Q8603
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A126086
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License Number State | CA
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