MEDICARE: DR. NHAT-LONG LAM PHAM M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	Q8603	TX
2	2085R0001X	Radiation Oncology Physician	A126086	CA

General Provider Information

NPI Number	:	1003102617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NHAT-LONG LAM PHAM M.D., PH.D.

Provider Business Mailing Address
First Line	:	507 FOX GLN
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-4318
Country	:	US
Telephone Number	:	858-309-2995
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9183
Country	:	US
Telephone Number	:	241-645-7615
Fax Number	:	214-645-7624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	08/16/2016

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