Provider Demographics
NPI:1386644342
Name:TRAN, DUNG T (MD)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 73701
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70033-3701
Mailing Address - Country:US
Mailing Address - Phone:504-779-9768
Mailing Address - Fax:504-887-3797
Practice Address - Street 1:4720 S I 10 SERVICE RD W
Practice Address - Street 2:STE 201-A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7404
Practice Address - Country:US
Practice Address - Phone:504-779-9768
Practice Address - Fax:504-887-3797
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA025373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1123897Medicaid
LA4E230Medicare ID - Type Unspecified
LA1123897Medicaid