Basic Information
| Provider Information | |||||||||
| NPI: | 1366638538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | NHI | ||||||||
| MiddleName: | LAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 DALLAS STREET | ||||||||
| Address2: | BAPTIST MEDICAL CENTER - HOSPITALIST OFFICE | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782051240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102976000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 DALLAS ST | ||||||||
| Address2: | HOSPITALIST OFFICE | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782051201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102976500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 07/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L939475 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M8250 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1366638538 | 01 | TX | SCOTT & WHITE HEALTH PLAN | OTHER | P00471688 | 01 | TX | RR MEDICARE | OTHER | 8AN223 | 01 | BC/BS | OTHER | 190584601 | 05 | TX | MEDICAID |