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General NPI Number Information
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NPI Number | 1609196989
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Entity Type | Individual
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Provider Name | PHUNG PHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 333 NW 70TH AVE STE 107
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City | PLANTATION
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State | FL
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Zip | 33317-2358
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Country | US
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Telephone | 954-998-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 8087 N SAVANNAH CIR
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City | DAVIE
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State | FL
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Zip | 33328-3031
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Country | US
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Telephone | 954-326-2781
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME118146
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License Number State | FL
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