Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 45822 | MN |
N | 208600000X | Surgeon | 45822 | MN |
N | 208200000X | Surgeon | ME107945 | FL |
N | 208600000X | Surgeon | ME107945 | FL |
N | 2086S0120X | Pediatric Surgery | 41418 | AZ |
Y | 2086S0120X | Pediatric Surgery | ME107945 | FL |
NPI | 1023080942 |
---|---|
Provider Name | Dr. Tuan Hoai Pham |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Lakeland, FL 33805-4543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031991-00 | (05) | FL |
H90006 | (02) |