Gary Pham

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

PSI 29735 Issued in FL

Practice address

1741 Red Cedar Drive Apt 20
Fort Myers, FL 33907

Phone

(714) 470-0377

NPI assigned

Aug 5, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1841676590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 RED CEDAR DRIVE APT 20",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33907",
            "telephone_number": "714-470-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 RED CEDAR DRIVE APT 20",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33907",
            "telephone_number": "714-470-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "GARY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "PSI 29735",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "INT 31104",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Klinton Joshua Pfeifle, P.A.-C
• Duke Michael Pfitzinger Jr., DO
• Maren Pfleger
• Alyssa Pham, DPM
• Chauchau Tu Pham, MD
• Linda Pham
• Tuan Duc Phan, M.D.
• Alexandra Rae Phelps, APRN
• Dwight Phelps, MD
• Alexander Philip, M.D.

• Student in an Organized Health Care Education/Training Program in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Student in an Organized Health Care Education/Training Program in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.