Provider Demographics
NPI:1598377137
Name:TRAN, TRAM
Entity Type:Individual
Prefix:
First Name:TRAM
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3514
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:817-334-1410
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3514
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant