Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 34009599 | OH |
NPI | 1265633341 |
---|---|
Provider Name | Phillip Pham |
First Address | West Chester, OH 45069-3371 |
Second Address | West Chester, OH 45069-3371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 11/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200962470 | (05) | IN |
2986845 | (05) | OH |
7100085070 | (05) | KY |