Provider Demographics
NPI:1114995305
Name:TRAN, THUC-NGUYEN VU (DO)
Entity Type:Individual
Prefix:DR
First Name:THUC-NGUYEN
Middle Name:VU
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GWEN
Other - Middle Name:VU
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4389 ARMISTICE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6310
Mailing Address - Country:US
Mailing Address - Phone:214-228-3844
Mailing Address - Fax:866-696-6755
Practice Address - Street 1:4100 FAIRWAY DR STE 320
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6537
Practice Address - Country:US
Practice Address - Phone:972-236-7608
Practice Address - Fax:972-236-7606
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5719207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5719OtherLICENSE
TXH12263Medicare UPIN