1427253012 NPI number — DR. VIVIEN DOAN PHAM MD

Table of content: DR. VIVIEN DOAN PHAM MD (NPI 1427253012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427253012 NPI number — DR. VIVIEN DOAN PHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHAM
Provider First Name:
VIVIEN
Provider Middle Name:
DOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427253012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 LOGANWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANGELO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76904-9571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-651-5155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 N LAKEMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-6618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME 100800 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3805159097 . This is a "MYUTMB 3805159097-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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