Provider Demographics
NPI:1013927110
Name:TRAN, MICHAEL LONG (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LONG
Last Name:TRAN
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 1:4704 HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-546-7979
Mailing Address - Fax:707-546-7667
Practice Address - Street 1:4704 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-546-7979
Practice Address - Fax:707-546-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG085353207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA159045000OtherUS DEPT OF LABOR
CAP00124747OtherRAILROAD MEDICARE
CA00G853530Medicare ID - Type Unspecified
CA159045000OtherUS DEPT OF LABOR