Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | N4167 | TX |
NPI | 1124259072 |
---|---|
Provider Name | Dat Quoc Tran |
First Address | Bellaire, TX 77401-4023 |
Second Address | Bellaire, TX 77401-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206121001 | (05) | TX |
8CD520 | BCBSTX (01) | TX |