Provider Demographics
NPI:1699809293
Name:DR PETER TRAN DO LC
Entity Type:Organization
Organization Name:DR PETER TRAN DO LC
Other - Org Name:DR. PETER TRAN D.O., FAMILY MEDICINE & GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-363-3288
Mailing Address - Street 1:1776 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5018
Mailing Address - Country:US
Mailing Address - Phone:702-363-3288
Mailing Address - Fax:702-363-3288
Practice Address - Street 1:1776 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5018
Practice Address - Country:US
Practice Address - Phone:702-363-3288
Practice Address - Fax:702-363-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1188207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506432Medicaid
NV100506432Medicaid
NVI17219Medicare UPIN