Provider Demographics
NPI:1629324991
Name:THOMAS T. TRAN MD PA ENNIS FAMILY MEDICINE
Entity Type:Organization
Organization Name:THOMAS T. TRAN MD PA ENNIS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TUNG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-875-2858
Mailing Address - Street 1:2203 W ENNIS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-8050
Mailing Address - Country:US
Mailing Address - Phone:972-875-2858
Mailing Address - Fax:972-875-2928
Practice Address - Street 1:2203 W ENNIS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-8050
Practice Address - Country:US
Practice Address - Phone:972-875-2858
Practice Address - Fax:972-875-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty