Provider Demographics
NPI:1114960911
Name:TRAN, THAO MINH PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:MINH PHUONG
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 1:5060 SW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6004
Mailing Address - Country:US
Mailing Address - Phone:305-669-7998
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR STE 707E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2151
Practice Address - Country:US
Practice Address - Phone:305-271-6159
Practice Address - Fax:305-271-6851
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103398208100000X
TXK7631208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation