Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME128776 | FL |
NPI | 1083961320 |
---|---|
Provider Name | Dr. Chauchau Tu Pham |
First Address | Fort Myers, FL 33908-3817 |
Second Address | Fort Myers, FL 33908-3817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2012 |
Last Update Date | 24/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
591315597 | TAX ID (01) | FL |