Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R2702 | AR |
NPI | 1043220791 |
---|---|
Provider Name | Dr. Pham Hieu Liem |
First Address | Little Rock, AR 72212-2900 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11878000000 | QUALCHOICE (01) | AR |
53973 | BCBS (01) | AR |
D84318 | (02) | AR |
R2702 | TRICARE (01) | AR |