Provider Demographics
NPI:1013228782
Name:LUONG, TRI (DO)
Entity Type:Individual
Prefix:DR
First Name:TRI
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W WHEATLAND RD
Mailing Address - Street 2:PAV III STE#360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4418
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:
Practice Address - Street 1:3335 W WHEATLAND RD
Practice Address - Street 2:SUITE #120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:972-298-9600
Practice Address - Fax:972-298-9700
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4884207Q00000X, 207QH0002X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338414101Medicaid
TX338414101Medicaid