Provider Demographics
NPI:1346353646
Name:TRAN, FAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10200 SW EASTRIDGE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5064
Mailing Address - Country:US
Mailing Address - Phone:503-280-4555
Mailing Address - Fax:503-280-4559
Practice Address - Street 1:10200 SW EASTRIDGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5064
Practice Address - Country:US
Practice Address - Phone:503-280-4555
Practice Address - Fax:503-280-4559
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500614183Medicaid
ORP01165691OtherRR MEDICARE- PROVIDENCE
ORR167363Medicare PIN
OR500614183Medicaid