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Deactivated NPI 1194090043 Deactivated / Inactive NPI Male Practitioner

Dr. Trung Pham , MD

General Practice • Fleming Island, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Trung Pham has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 11, 2012
NPI Deactivation Date March 02, 2018
Total Practice Duration ~6 Years of Practice (2012 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Trung Pham, MD was a registered General Practice practicing in Fleming Island, FL. Throughout an active medical career spanning 6 years, Dr. Pham provided care at the practice location at 1952 VISTA LAKES DR until profile deactivation on 2018-03-02.

Practice Location & Contact Primary Location

Practice Address

1952 Vista Lakes Dr

Fleming Island, FL 320037312

Telephone 9042695647

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Fleming Island, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 26.1 Yrs
Regional Practice Density
1 Specialists

Practicing in Fleming Island, FL (2490 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License GA 051998

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 02, 2018

Record deactivated on March 02, 2018

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NPI Profile Active December 31, 2015

NPI status registered as active in NPPES database

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Updated Practice Location December 31, 2015

Registered at 1952 VISTA LAKES DR, FLEMING ISLAND, FL 320037312 (Tel: 9042695647)

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Updated Business Mailing Address December 31, 2015

Registered at 1952 VISTA LAKES DR, FLEMING ISLAND, FL 320037312

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Provider Name / Credentials Updated December 31, 2015

Recorded as TRUNG PHAM, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 31, 2015

General Practice (License #051998 in GA)

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Initial NPI Registration & Enumeration March 11, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1194090043
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 11, 2012
Last Update: December 31, 2015
Deactivation Date: March 02, 2018
Update or Correct Profile

Mailing Address

1952 Vista Lakes Dr

Fleming Island, FL 320037312

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.