MEDICARE: JOHN-PAUL PHAM

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	207RI0011X	Interventional Cardiology Physician	ME107417	FL

General Provider Information

NPI Number	:	1154802833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN-PAUL PHAM

Provider Business Mailing Address
First Line	:	4141 SOUTHPOINT DR E STE D
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8061
Country	:	US
Telephone Number	:	904-513-3179
Fax Number	:	904-337-1641

Provider Business Practice Location Address
First Line	:	4141 SOUTHPOINT DRIVE EAST
Second Line	:	SUITE D
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-513-3179
Fax Number	:	904-337-1641

Authorized Official
Title or Position	:	M.D - OWNER
Name	:	DR. JOHN-PAUL PHAM
Credential	:	MD
Telephone Number	:	904-513-3179

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	09/13/2019

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