Provider Demographics
NPI:1811079353
Name:STAFFORD, THUY-VAN TRAN (MD)
Entity type:Individual
Prefix:
First Name:THUY-VAN
Middle Name:TRAN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THUY-VAN
Other - Middle Name:PHAM
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN MSB 3.242
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-5733
Mailing Address - Fax:713-500-5794
Practice Address - Street 1:6431 FANNIN MSB 3.242
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-5733
Practice Address - Fax:713-500-5794
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL51572080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152278101Medicaid
8G6200OtherBCBS TX
085387101OtherMEDICAID TX GROUP NUMBER