Provider Demographics
NPI:1104807528
Name:PHAM, DANG (MD)
Entity type:Individual
Prefix:DR
First Name:DANG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 PALMER WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4081
Mailing Address - Country:US
Mailing Address - Phone:832-930-8890
Mailing Address - Fax:713-929-3526
Practice Address - Street 1:16750 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2543
Practice Address - Country:US
Practice Address - Phone:281-453-7110
Practice Address - Fax:281-440-2020
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK33932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116256205Medicaid
TX116256204Medicaid
86887RMedicare PIN
84390RMedicare PIN
300128570Medicare PIN
TX116256205Medicaid
TX116256204Medicaid