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General NPI Number Information
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NPI Number | 1578755898
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Entity Type | Organization
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Legal Business Name | RICHARD PHAM MD PA
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 492 SPRINGHILL ST SUITE A
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City | JASPER
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State | TX
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Zip | 75951-4922
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Country | US
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Telephone | 409-381-5750
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Fax | 409-384-2018
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Provider Business Mailing Address
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Address Line | 492 SPRINGHILL ST SUITE A
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City | JASPER
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State | TX
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Zip | 75951-4922
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Country | US
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Telephone | 409-381-5750
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Fax | 409-384-2018
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD D PHAM
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Credential | MD
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Telephone | 409-381-5750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K2098
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License Number State | TX
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