Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD 60158482 | WA |
NPI | 1033313820 |
---|---|
Provider Name | Long Duc Tran |
First Address | Winooski, VT 05404-2262 |
Second Address | Tacoma, WA 98415-0299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 27/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP2-0019297 | INSTITUTIONAL PERMIT (01) |