Provider Demographics
NPI:1912010836
Name:TRAN, VAN THI (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 ROBLEDO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3059
Mailing Address - Country:US
Mailing Address - Phone:972-338-5574
Mailing Address - Fax:469-393-7206
Practice Address - Street 1:1000 E BELT LINE RD STE 112
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6282
Practice Address - Country:US
Practice Address - Phone:972-338-5574
Practice Address - Fax:469-393-7206
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135115704Medicaid
TX135115701Medicaid
TX135115707Medicaid
TX751700137OtherFEDERAL TAX ID
TXC22753Medicare UPIN
TX135115704Medicaid