Doctor Name: | MR. HIEP QUANG PHAM |
NPI Number: | 1376617357 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME045427 |
Business Practice Address: | 639 N Mills Ave Orlando, FL - 32803 |
Business Phone Number: | 4078973260 |
Business Fax Number: | 4078971112 |
Mailing Address: | 639 N Mills Ave, ORLANDO |
State: | FL |
Postal Code: | 32803 |
Phone Number: | 4078973260 |
Fax Number: | 4078971112 |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 07/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME045427 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |