Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125-057211 | IL |
N | 111NI0900X | Internist | 125-057211 | IL |
N | 207R00000X | Internist | MD157726 | OR |
N | 111NI0900X | Internist | MD157726 | OR |
NPI | 1003045709 |
---|---|
Provider Name | Dr. Victor Nguyen Pham |
First Address | Anthem, AZ 85086-0430 |
Second Address | Portland, OR 97225-6603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500647926 | (05) | OR |
58475 | AZ LICENSE (01) | AZ |
P01701362 | RR MEDICARE - PH&S - OREGON (PMG) (01) | OR |