Provider Demographics
NPI:1164501722
Name:TRAN, DRISSANA T (MD)
Entity Type:Individual
Prefix:DR
First Name:DRISSANA
Middle Name:T
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 1:1536 BREWSTER CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6417
Mailing Address - Country:US
Mailing Address - Phone:503-589-1457
Mailing Address - Fax:503-589-1457
Practice Address - Street 1:875 OAK ST SE STE 3070
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3979
Practice Address - Country:US
Practice Address - Phone:503-585-7454
Practice Address - Fax:503-585-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF80655Medicare UPIN
OR011WCGBGR1Medicare ID - Type UnspecifiedWITH HEALTHFIRST
OR113103Medicare Oscar/Certification