Provider Demographics
NPI:1548437338
Name:PHAM, BICHSON (DO)
Entity type:Individual
Prefix:DR
First Name:BICHSON
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTH MUNDO
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528-7418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH MUNDO
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528-7418
Practice Address - Country:US
Practice Address - Phone:575-759-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK3526Medicaid
NM8HN083OtherPROVIDER MEDICARE #
NM17522056Medicaid
NMHSZ196OtherMEDICARE PART B
NM320057Medicare Oscar/Certification