Provider Demographics
NPI:1487697546
Name:TRAN, NGUYEN (DO)
Entity type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:
Last Name:TRAN
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 1:3602 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6236
Mailing Address - Country:US
Mailing Address - Phone:972-487-7619
Mailing Address - Fax:972-487-7682
Practice Address - Street 1:3602 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6236
Practice Address - Country:US
Practice Address - Phone:972-487-7619
Practice Address - Fax:972-487-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177412701Medicaid
TX0097NHOtherBLUE CROSS BLUE SHIELD
TX00617ZMedicare PIN
TX177412701Medicaid