Provider Demographics
NPI:1174589634
Name:PHAM, JOANNE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIEM-LINH
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 W BUSINESS 380
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3281
Mailing Address - Country:US
Mailing Address - Phone:940-627-7997
Mailing Address - Fax:940-627-7416
Practice Address - Street 1:1600 W BUSINESS 380
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3281
Practice Address - Country:US
Practice Address - Phone:940-627-7997
Practice Address - Fax:940-627-7416
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8250207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00194346OtherRAILROAD
TX8P2330OtherBCBS
TX1669608Medicaid
TX8C0687Medicare PIN