Provider Demographics
NPI:1790895118
Name:VO, TRANG THI THU (RD LD)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:THI THU
Last Name:VO
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAFV3375056207Q00000X
TXR1148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-002OtherTRICARE
TX8GM895OtherBCBS
TX370890102Medicaid
TX75-0818167-015OtherTRICARE
TX370890101Medicaid
TX370890104OtherBCBS
TXP01811992OtherMEDICARE RAIL ROAD
TX370890103Medicaid
TX8GM894OtherBCBS
TXP01793346OtherRAIL ROAD MEDICARE
TX75-0818167-022OtherTRICARE
TX75-0818167-044OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-0818167-048OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8GM896OtherBCBS
TX8GM897OtherBCBS
TXP01811494OtherRAIL ROAD MEDICARE
TX75-1976930-005OtherTRICARE
TXP01793346OtherRAIL ROAD MEDICARE
TX8GM897OtherBCBS
TX75-0818167-044OtherTRICARE
TX553274YS6PMedicare PIN