Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | P4884 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | P4884 | TX |
NPI | 1013228782 |
---|---|
Provider Name | Dr. Tri Luong |
First Address | Dallas, TX 75237-4418 |
Second Address | Dallas, TX 75237-3460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
338414101 | (05) | TX |