Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 31352 | OK |
NPI | 1932596681 |
---|---|
Provider Name | Trang Pham |
First Address | Oklahoma City, OK 73104 |
Second Address | Oklahoma City, OK 73104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 18/06/2019 |