Provider Demographics
NPI:1023041126
Name:TRAN, QUAN DINH (MD)
Entity Type:Individual
Prefix:DR
First Name:QUAN
Middle Name:DINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:4211 VANDYKE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8004
Practice Address - Country:US
Practice Address - Phone:813-264-6490
Practice Address - Fax:813-321-1878
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111470208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004424600Medicaid
AL51535617OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL1023041126Medicaid
FL004424600Medicaid
FLI57555Medicare UPIN
FLF7254Medicare PIN
AL51535617OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA