Provider Demographics
NPI:1679516215
Name:TRAN, QUANG T (MD)
Entity Type:Individual
Prefix:DR
First Name:QUANG
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:724 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4101
Practice Address - Country:US
Practice Address - Phone:850-769-0336
Practice Address - Fax:850-769-6202
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067907207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378051100Medicaid
26937OtherBLUE CROSS
040011870OtherRAILROAD MEDICARE
FL257724100Medicaid
26937OtherBLUE CROSS
26937ZMedicare ID - Type Unspecified
K0538Medicare PIN