Provider Demographics
NPI:1083840094
Name:TRAN, BAOTRAM (MD)
Entity Type:Individual
Prefix:
First Name:BAOTRAM
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16580 S POST RD APT 103
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3567
Mailing Address - Country:US
Mailing Address - Phone:267-816-6166
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 37TH AVE STE 803
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2751
Practice Address - Country:US
Practice Address - Phone:786-670-1297
Practice Address - Fax:239-320-9873
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129415208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program