MEDICARE: MATT HAI PHAM MD

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	207R00000X	Internal Medicine Physician	11052	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003917055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT HAI PHAM MD

Provider Business Mailing Address
First Line	:	500 N RAINBOW BLVD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1082
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-947-6740

Provider Business Practice Location Address
First Line	:	500 N RAINBOW BLVD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1082
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-947-6740

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	05/20/2014

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