Individual
CHAU N PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
8325 WHITLEY RD, SUITE: 100, WATAUGA, TX 76148-2487
(817) 479-1181
(817) 918-4432
Mailing address
8325 WHITLEY RD, STE 100, WATAUGA, TX 76148-2493
(817) 479-1181
(817) 918-4432
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L0508
TX
207QG0300X
Geriatric Medicine (Family Medicine) Physician
L0508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043666901
—
TX
01
—
DH2407
MEDICARE RAILROAD
TX
01
—
P00480556
MEDICARE RAILROAD
—
Enumeration date
04/18/2006
Last updated
10/08/2021
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