Individual
LONG HENRY PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2206 E VILLA MARIA RD, BRYAN, TX 77802-2547
(979) 776-4600
(979) 774-0877
Mailing address
2206 E VILLA MARIA RD, BRYAN, TX 77802-2547
(979) 776-4600
(979) 774-0877
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
J0861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047977601
—
TX
Enumeration date
08/31/2006
Last updated
02/23/2021
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