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NPI Code Detail

MEDICARE: MR. LAN N PHAM M.D.

MEDICARE: MR. LAN N 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
1207R00000XInternal Medicine PhysicianMD00037318WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10256048OTHERWAWASHINGTON DOL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548264252
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LAN N PHAM M.D.
Provider Business Mailing Address
First Line : 1115 SE 164TH AVE
Second Line : DEPT. 358
City : VANCOUVER
State : WA
Zip : 98683-9324
Country : US
Telephone Number : 360-729-1462
Fax Number : 360-729-3104
Provider Business Practice Location Address
First Line : 1615 DELAWARE ST
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2367
Country : US
Telephone Number : 360-501-3601
Fax Number : 360-501-3648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 03/06/2017

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