Provider Demographics
NPI:1265489330
Name:TRAN, LILY N (DO)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:N
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2550 RIVER PARK PLZ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0920
Mailing Address - Country:US
Mailing Address - Phone:817-731-1289
Mailing Address - Fax:817-731-1291
Practice Address - Street 1:2550 RIVER PARK PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0920
Practice Address - Country:US
Practice Address - Phone:817-731-1289
Practice Address - Fax:817-731-1291
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185208903Medicaid
TX185208905Medicaid
TX185208902Medicaid
TX8L16299Medicare PIN
TX8L11667Medicare PIN
TX185208903Medicaid
TX8J4884Medicare PIN