Provider Demographics
NPI:1407213903
Name:TRAN, AN QUOC (DPM)
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N 56TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1642
Mailing Address - Country:US
Mailing Address - Phone:954-218-6616
Mailing Address - Fax:
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-218-4095
Practice Address - Fax:877-476-7125
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3787213EP1101X
IN07001235A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine