Provider Demographics
NPI:1083820781
Name:LUONG, MINH TRAN (MD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:TRAN
Last Name:LUONG
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 1:5602 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8813
Mailing Address - Country:US
Mailing Address - Phone:480-854-9004
Mailing Address - Fax:480-854-8543
Practice Address - Street 1:5602 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8813
Practice Address - Country:US
Practice Address - Phone:480-854-9004
Practice Address - Fax:480-854-8543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine