Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | L9939 | TX |
Y | 207R00000X | Internist | L9939 | TX |
Y | 111NI0900X | Internist | L9939 | TX |
N | 208000000X | Pediatrician | L9939 | TX |
NPI | 1720068174 |
---|---|
Provider Name | Dr. Loc Hoang Trieu |
First Address | Dallas, TX 75251-2100 |
Second Address | Dallas, TX 75251-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 18/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167756902 | (05) | TX |
8J1777 | BCBS (01) | TX |
I18200 | (02) | TX |