Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME111470 | FL |
Y | 208600000X | Surgeon | ME111470 | FL |
NPI | 1023041126 |
---|---|
Provider Name | Dr. Quan Dinh Tran |
First Address | Clearwater, FL 33757-8744 |
Second Address | Lutz, FL 33558-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 13/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004424600 | (05) | FL |
1023041126 | (05) | AL |
51535617 | BLUE CROSS AND BLUE SHIELD OF ALABAMA (01) | AL |
I57555 | (02) | |
I57555 | (02) | FL |