Provider Demographics
NPI:1417042193
Name:LE, TRANG DIEM (MD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:DIEM
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3507
Mailing Address - Country:US
Mailing Address - Phone:972-637-1300
Mailing Address - Fax:866-353-7586
Practice Address - Street 1:634 UPTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3507
Practice Address - Country:US
Practice Address - Phone:972-637-1300
Practice Address - Fax:866-353-7586
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7625207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0825723OtherAETNA HMO
TX127222106Medicaid
4460608OtherAETNA PPO
751622524OtherUNITED HEALTHCARE
TX3358824OtherBCBD BLUE LINK
0825723OtherAETNA POS
TX127222107Medicaid
TX180021846OtherMEDICARE RR DALLAS COUNTY
TX86771XOtherBCBS ID
TX0016DQOtherBCBS GROUP #
TX180034451OtherMEDICARE RR ELLIS COUNTY
751622524OtherUNITED HEALTHCARE
TX86771XOtherBCBS ID
TX127222107Medicaid
0825723OtherAETNA HMO