Active NPI
Nathan Pham, M.D
- Pharmacist
- San Antonio, TX
National Provider Identifier
1114245339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS58864
- Practice address
- 4511 Briar FRST
San Antonio, TX 78217-1415 - Phone
- (305) 496-4409
- NPI assigned
- May 12, 2010
- Reactivated
- Sep 4, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | BP10037842 | TX | |
| Pharmacist | 183500000X | PS58864 | FL | Primary |
Addresses
Primary practice location
4511 Briar FRST
San Antonio, TX 78217-1415
Mailing address
4511 Briar FRST
San Antonio, TX 78217-1415
Phone (305) 496-4409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS58864 | FL | MD | Pharmacist |
| BP10037842 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599177600000",
"number": "1114245339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4511 BRIAR FRST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782171415",
"telephone_number": "305-496-4409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4511 BRIAR FRST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782171415",
"telephone_number": "305-496-4409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "NATHAN",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-12",
"last_updated": "2020-09-04",
"certification_date": "2020-09-04",
"deactivation_date": "2014-03-12",
"reactivation_date": "2020-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "BP10037842",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS58864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.