MEDICARE: DR. TONY AI PHAM M.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	2084P0802X	Addiction Psychiatry Physician	M5883	TX
2	2084P0800X	Psychiatry Physician	M5883	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245419225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY AI PHAM M.D.

Provider Business Mailing Address
First Line	:	2247 GOLDSMITH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1118
Country	:	US
Telephone Number	:	713-376-3459
Fax Number	:	832-369-7665

Provider Business Practice Location Address
First Line	:	1315 ST JOSEPH PKWY 1307
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8236
Country	:	US
Telephone Number	:	713-376-3459
Fax Number	:	832-369-7665

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	09/27/2024

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