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General NPI Number Information
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NPI Number | 1154802833
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Entity Type | Organization
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Legal Business Name | JOHN-PAUL PHAM
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 4141 SOUTHPOINT DRIVE EAST SUITE D
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-513-3179
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Fax | 904-337-1641
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Provider Business Mailing Address
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Address Line | 4141 SOUTHPOINT DR E STE D
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8061
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Country | US
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Telephone | 904-513-3179
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Fax | 904-337-1641
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Authorized Official
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Title or Position | M.D - OWNER
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Name | DR. JOHN-PAUL PHAM
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Credential | MD
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Telephone | 904-513-3179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME107417
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License Number State | FL
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