Provider Demographics
NPI:1255661096
Name:TRAN, DUY DUY THUC (PA-C)
Entity Type:Individual
Prefix:
First Name:DUY DUY
Middle Name:THUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5561
Mailing Address - Country:US
Mailing Address - Phone:970-686-0124
Mailing Address - Fax:970-686-0845
Practice Address - Street 1:1455 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-686-0124
Practice Address - Fax:970-686-0845
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
CO0003132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant