Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 37275 | KY |
NPI | 1336140698 |
---|---|
Provider Name | Thao H Pham |
First Address | Elizabethtown, KY 42701-2520 |
Second Address | Elizabethtown, KY 42701-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 27/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000301574 | ANTHEM BCBS (01) | KY |
2649647000 | PASSPORT ADVANTAGE (01) | KY |
50001581 | PASSPORT HEALTH PLAN (01) | KY |
64062102 | (05) | KY |
H79665 | (02) | KY |
H79665 | DEA (01) | KY |