Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G085353 | CA |
NPI | 1013927110 |
---|---|
Provider Name | Mr. Michael Long Tran |
First Address | Santa Rosa, CA 95405 |
Second Address | Santa Rosa, CA 95405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159045000 | US DEPT OF LABOR (01) | CA |
G80494 | (02) | |
P00124747 | RAILROAD MEDICARE (01) | CA |