Provider Demographics
NPI:1982890836
Name:TRAN, ANDY V (MD)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:V
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 1:365 W HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4441
Mailing Address - Country:US
Mailing Address - Phone:318-283-5999
Mailing Address - Fax:318-283-7998
Practice Address - Street 1:365 W HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4441
Practice Address - Country:US
Practice Address - Phone:318-283-5999
Practice Address - Fax:318-283-7998
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23532207Q00000X
LA023532208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495794Medicaid
LA1495794Medicaid