Individual
MI PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 LITTLE OAK WAY, ROUND ROCK, TX 78681-5516
(122) 558-8685
(512) 255-8869
Mailing address
4900 MUELLER BLVD STE 3S.066C, AUSTIN, TX 78723-3079
(512) 324-0165
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
BP10059353
TX
208000000X
Pediatrics Physician
Primary
S6710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413750701
—
TX
Enumeration date
06/03/2017
Last updated
10/01/2020
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