Provider Demographics
NPI:1497721385
Name:TRAN, TRUC T (DO)
Entity Type:Individual
Prefix:DR
First Name:TRUC
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR STE 184
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3434
Mailing Address - Country:US
Mailing Address - Phone:407-296-1923
Mailing Address - Fax:407-636-7850
Practice Address - Street 1:10000 W COLONIAL DR STE 184
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3434
Practice Address - Country:US
Practice Address - Phone:407-296-1923
Practice Address - Fax:407-636-7850
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81891OtherBCBS
FL268497700Medicaid
FLP00062167OtherRR MEDICARE
U0809XMedicare PIN
FLH86122Medicare UPIN
FLU0809ZMedicare ID - Type Unspecified