Provider Demographics
NPI:1811959729
Name:TRAN, JOHN VAN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN PHUC
Other - Middle Name:VAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:505 EICHENFELD DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5985
Mailing Address - Country:US
Mailing Address - Phone:813-685-6922
Mailing Address - Fax:813-685-8308
Practice Address - Street 1:505 EICHENFELD DR
Practice Address - Street 2:SUITE 108
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5985
Practice Address - Country:US
Practice Address - Phone:813-685-6922
Practice Address - Fax:813-685-8308
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3132213E00000X, 213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65875YMedicare PIN
FL65875Medicare ID - Type Unspecified
FL5736880001Medicare NSC