Provider Demographics
NPI:1003201005
Name:TRAN, ELISE (DO)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TRAN
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 1:1545 E SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6465
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:817-416-0108
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6465
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:817-416-0108
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
TXS0237208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program