Provider Demographics
NPI:1306869466
Name:PHAM, THAI MINH (MD)
Entity type:Individual
Prefix:DR
First Name:THAI
Middle Name:MINH
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 1:713 W LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5994
Mailing Address - Country:US
Mailing Address - Phone:407-240-9905
Mailing Address - Fax:407-240-6216
Practice Address - Street 1:713 W LANCASTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5994
Practice Address - Country:US
Practice Address - Phone:407-240-9905
Practice Address - Fax:407-240-6216
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252527500Medicaid
FLG65107Medicare UPIN
FL252527500Medicaid