Provider Demographics
NPI:1093714388
Name:LE, TRUC JR (DO)
Entity Type:Individual
Prefix:DR
First Name:TRUC
Middle Name:
Last Name:LE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3003 S LOOP W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1301
Mailing Address - Country:US
Mailing Address - Phone:713-662-9500
Mailing Address - Fax:713-662-9501
Practice Address - Street 1:3003 S LOOP W
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1301
Practice Address - Country:US
Practice Address - Phone:713-662-9500
Practice Address - Fax:713-662-9501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080182303OtherRAILROAD MEDICARE
TX036373102Medicaid
TX8F5660OtherBCBS OF TEXAS
TX8461B3Medicare ID - Type Unspecified
TX8F5660OtherBCBS OF TEXAS
TX8K1815Medicare PIN