Provider Demographics
NPI:1770505067
Name:DANG, TRI DUC (DO)
Entity Type:Individual
Prefix:
First Name:TRI
Middle Name:DUC
Last Name:DANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 BARLITE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1365
Mailing Address - Country:US
Mailing Address - Phone:210-977-9332
Mailing Address - Fax:210-921-3357
Practice Address - Street 1:5730 SILENT FOREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2125
Practice Address - Country:US
Practice Address - Phone:210-523-7150
Practice Address - Fax:210-704-2882
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1015207P00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH28658Medicare UPIN