Provider Demographics
NPI:1740202910
Name:TRUONG, THAO MING (MD)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:MING
Last Name:TRUONG
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 1:815 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-3025
Mailing Address - Country:US
Mailing Address - Phone:361-552-0325
Mailing Address - Fax:361-552-8759
Practice Address - Street 1:815 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3025
Practice Address - Country:US
Practice Address - Phone:361-552-0325
Practice Address - Fax:361-552-8759
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXK2128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXK2128OtherTX STATE LICENSE
TXG69853Medicare UPIN
TXTXB148484OtherMEDICARE
TX8B5116Medicare ID - Type Unspecified
TXTXK2128OtherTX STATE LICENSE