Provider Demographics
NPI:1063868420
Name:PHAM, THY (PA-C)
Entity type:Individual
Prefix:
First Name:THY
Middle Name:
Last Name:PHAM
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W. COLORADO BLVD
Mailing Address - Street 2:PAVILION II SUITE 933
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6800
Mailing Address - Country:US
Mailing Address - Phone:214-947-3684
Mailing Address - Fax:214-947-3686
Practice Address - Street 1:221 W. COLORADO BLVD
Practice Address - Street 2:PAVILION II SUITE 933
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6800
Practice Address - Country:US
Practice Address - Phone:214-947-3684
Practice Address - Fax:214-947-3686
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant