Provider Demographics
NPI:1215138714
Name:PHAM, ANTHONY TAM (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TAM
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TAM
Other - Middle Name:HUU
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6800 BUFFALO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1405
Mailing Address - Country:US
Mailing Address - Phone:281-818-5333
Mailing Address - Fax:
Practice Address - Street 1:20303 KERMIER RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8743
Practice Address - Country:US
Practice Address - Phone:281-818-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.0000322081P2900X
TXM89172081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine