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General NPI Number Information
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NPI Number | 1659558195
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Entity Type | Organization
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Legal Business Name | CONNIE PHAM, M.D.,P.A.
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 2118 SCENIC DR
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City | GEORGETOWN
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State | TX
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Zip | 78626-7728
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Country | US
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Telephone | 512-863-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 2118 SCENIC DR
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City | GEORGETOWN
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State | TX
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Zip | 78626-7728
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Country | US
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Telephone | 512-863-5678
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. CONNIE L. PHAM
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Credential | M.D.
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Telephone | 51288635678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | H8321
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License Number State | TX
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