Provider Demographics
NPI:1225088842
Name:PHAM, THOMAS ANH (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANH
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 1:1420 W MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2090
Mailing Address - Country:US
Mailing Address - Phone:303-466-4081
Mailing Address - Fax:303-466-1866
Practice Address - Street 1:1420 W MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2090
Practice Address - Country:US
Practice Address - Phone:303-466-1866
Practice Address - Fax:303-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0053133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27727238Medicaid
MO207240201Medicaid
269E003Medicare ID - Type Unspecified