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NPI Code Detail

MEDICARE: DR. THOMAS S PHAM MD

MEDICARE: DR. THOMAS S 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
1207N00000XDermatology Physician4301069802MI
2207N00000XDermatology PhysicianME118627FL

Other Identifiers

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

General Provider Information

NPI Number : 1790776995
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS S PHAM MD
Provider Business Mailing Address
First Line : 2489 DIPLOMAT PKWY E
Second Line :
City : CAPE CORAL
State : FL
Zip : 33909-5422
Country : US
Telephone Number : 239-652-1800
Fax Number : 248-655-0372
Provider Business Practice Location Address
First Line : 2489 DIPLOMAT PKWY E
Second Line :
City : CAPE CORAL
State : FL
Zip : 33909-5422
Country : US
Telephone Number : 239-652-1800
Fax Number : 248-655-0372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 06/22/2015

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