Provider Demographics
NPI:1417954389
Name:QUANG TRONG LE DO PA
Entity Type:Organization
Organization Name:QUANG TRONG LE DO PA
Other - Org Name:RIVER PARK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG TRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-731-1289
Mailing Address - Street 1:2550 RIVER PARK PLZ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0920
Mailing Address - Country:US
Mailing Address - Phone:817-731-1289
Mailing Address - Fax:817-731-1291
Practice Address - Street 1:2550 RIVER PARK PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0920
Practice Address - Country:US
Practice Address - Phone:817-731-1289
Practice Address - Fax:817-731-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168553902Medicaid
TX00620XMedicare PIN
I20924Medicare UPIN