Provider Demographics
NPI:1922103191
Name:TRAM, TRACY PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:PHUONG
Last Name:TRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MCKEE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1618
Mailing Address - Country:US
Mailing Address - Phone:408-926-2420
Mailing Address - Fax:408-926-2422
Practice Address - Street 1:2360 MCKEE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1618
Practice Address - Country:US
Practice Address - Phone:408-926-2420
Practice Address - Fax:408-926-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A615491Medicare ID - Type Unspecified
CAG93935Medicare UPIN
CA00A615490Medicare ID - Type Unspecified