Basic Information
| Provider Information | |||||||||
| NPI: | 1285207449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | MINH-DUC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2269 STABLERIDGE DR | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133716265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1635 NORTH LOOP W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138673335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 852593 | TX | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.