Provider Demographics
NPI:1679036156
Name:TRAN, MATTHEW VUONG PHUC
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VUONG PHUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GARTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3157
Mailing Address - Country:US
Mailing Address - Phone:281-837-7587
Mailing Address - Fax:281-837-7443
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2122
Practice Address - Country:US
Practice Address - Phone:281-837-7587
Practice Address - Fax:281-837-7443
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV7670207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program