Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 3749 | OK |
Y | 111NN1001X | Nutrition | 9240 | TX |
NPI | 1295004208 |
---|---|
Provider Name | Dr. Binh Cong Pham |
First Address | Lewisville, TX 75067-8117 |
Second Address | Flower Mound, TX 75022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2011 |
Last Update Date | 20/12/2011 |