Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 301810 | LA |
NPI | 1194059386 |
---|---|
Provider Name | Dr. Minh Q Tran |
First Address | Shreveport, LA 71118-3119 |
Second Address | Shreveport, LA 71118-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 19/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2422481 | (05) | LA |