Basic Information
| Provider Information | |||||||||
| NPI: | 1487851358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3648 W ANTHEM WAY | ||||||||
| Address2: | SUITE A100 | ||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850867001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346444 | ||||||||
| FaxNumber: | 6234346448 | ||||||||
| Practice Location | |||||||||
| Address1: | 3648 W ANTHEM WAY | ||||||||
| Address2: | SUITE A100 | ||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850867001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346444 | ||||||||
| FaxNumber: | 6234346448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 01/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 5273 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.