MEDICARE: DR. THERESA THIEN-HOANG 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	207R00000X	Internal Medicine Physician	J7832	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	191785801	OTHER	TX	GRP TPI #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972531705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA THIEN-HOANG PHAM M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 27337
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755
Country	:	US
Telephone Number	:	512-775-9877
Fax Number	:	512-476-9892

Provider Business Practice Location Address
First Line	:	6521 LADERA NORTE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755
Country	:	US
Telephone Number	:	512-755-9877
Fax Number	:	512-476-9892

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/05/2009

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