Provider Demographics
NPI:1275737868
Name:TRAN, MAI THI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2715 OSLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1051
Mailing Address - Country:US
Mailing Address - Phone:972-206-2940
Mailing Address - Fax:972-602-7261
Practice Address - Street 1:2715 OSLER DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1051
Practice Address - Country:US
Practice Address - Phone:972-206-2940
Practice Address - Fax:972-602-7261
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0017510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275737868Medicaid
TX11417134255Medicaid
TX11417134255Medicaid