Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0 | NJ |
NPI | 1023677366 |
---|---|
Provider Name | Dr. Jacques Tran |
First Address | Philadelphia, PA 19130-1322 |
Second Address | Stratford, NJ 08084-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 22/05/2020 |