| Doctor Name: | DR. BAO LAN DUC PHAM |
| NPI Number: | 1326357856 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | P6244 |
| Business Practice Address: | 712 N Washington Ave Suite 101 Dallas, TX - 752461619 |
| Business Phone Number: | 2148268822 |
| Business Fax Number: | |
| Mailing Address: | 2935 Arbusto, GRAND PRAIRIE |
| State: | TX |
| Postal Code: | 750540150 |
| Phone Number: | 2142679360 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2010 |
| NPI Last Update Date: | 05/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | P6244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |