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General NPI Number Information
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NPI Number | 1518772433
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Entity Type | Organization
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Legal Business Name | EVI DERMATOLOGY PLLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1512 SW 119TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-4930
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Country | US
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Telephone | 405-310-6000
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Fax | 405-280-1398
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Provider Business Mailing Address
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Address Line | 1512 SW 119TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-4930
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Country | US
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Telephone | 405-310-6000
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Fax | 405-280-1398
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Authorized Official
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Title or Position | OWNER, CEO, PRESIDENT
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Name | QUY PHAM
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Credential | M.D.
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Telephone | 405-310-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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