Individual
LISA PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3231 S NATIONAL AVE STE 300, SPRINGFIELD, MO 65807-7304
(417) 888-5658
Mailing address
3231 S NATIONAL AVE STE 300, SPRINGFIELD, MO 65807-7304
(417) 888-5658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2015003729
MO
207R00000X
Internal Medicine Physician
G80996
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275502379
—
MO
01
—
2015003729
MO LICENSE
MO
Enumeration date
03/14/2006
Last updated
08/25/2022
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