Provider Demographics
NPI:1144654831
Name:PHAM, ANHTUAN (MD, MPH, MHA, CAC II)
Entity type:Individual
Prefix:
First Name:ANHTUAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD, MPH, MHA, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27705
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-0705
Mailing Address - Country:US
Mailing Address - Phone:720-308-0195
Mailing Address - Fax:303-245-0119
Practice Address - Street 1:1700 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5256
Practice Address - Country:US
Practice Address - Phone:303-238-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6852101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)