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General NPI Number Information
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NPI Number | 1053581686
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Entity Type | Organization
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Legal Business Name | ESPIRITUS SPINE & PAIN REHAB PA
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 20303 KERMIER RD
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City | WALLER
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State | TX
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Zip | 77484-8743
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Country | US
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Telephone | 281-818-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 20303 KERMIER RD
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City | WALLER
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State | TX
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Zip | 77484-8743
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Country | US
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Telephone | 281-818-5333
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ANTHONY TAM PHAM
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Credential | D.O.
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Telephone | 281-818-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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