Individual
HAI VAN PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4800 FREDERICKSBURG RD, STE 127, SAN ANTONIO, TX 78229-3628
(210) 733-5072
(210) 733-8649
Mailing address
PO BOX 1239, TROY, MI 48099-1239
(248) 824-6600
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
J9781
TX
207QG0300X
Geriatric Medicine (Family Medicine) Physician
J9781
TX
207R00000X
Internal Medicine Physician
Primary
J9781
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002MU
GROUP BCBS OF TX
TX
05
—
179041201
—
TX
01
—
P00296211
RAIL ROAD MEDICARE
TX
Enumeration date
09/13/2006
Last updated
09/04/2020
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