Provider Demographics
NPI:1760456487
Name:PHAM, PHUC H (MD)
Entity type:Individual
Prefix:DR
First Name:PHUC
Middle Name:H
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1747 E MORTEN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-589-0370
Mailing Address - Fax:602-589-0650
Practice Address - Street 1:1747 E MORTEN
Practice Address - Street 2:SUITE 303
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-589-0370
Practice Address - Fax:602-589-0650
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH14293Medicare UPIN
AZWMBFH-61886Medicare ID - Type Unspecified