Individual
TRI PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
133 CHARLES AVE, SHREVEPORT, LA 71105-3719
(318) 617-6708
Mailing address
PO BOX 1684, SHREVEPORT, LA 71165-1684
(480) 923-4675
(866) 276-8064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD206191
LA
207Q00000X
Family Medicine Physician
Q9881
TX
208100000X
Physical Medicine & Rehabilitation Physician
206191
LA
Other
Enumeration date
04/30/2010
Last updated
07/19/2022
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