Provider Demographics
NPI:1043399819
Name:PHAM, CHRISTOPHER JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 NORTHBROOKE PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8088
Mailing Address - Country:US
Mailing Address - Phone:239-325-9278
Mailing Address - Fax:239-325-9268
Practice Address - Street 1:2515 NORTHBROOKE PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8088
Practice Address - Country:US
Practice Address - Phone:239-325-9278
Practice Address - Fax:239-325-9268
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9899207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR401AMedicare UPIN