Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 005721 | NY |
Y | 222Z00000X | Podiatrist | 005721 | NY |
NPI | 1063519973 |
---|---|
Provider Name | Paul Cu Tran |
First Address | Malone, NY 12953-1747 |
Second Address | Malone, NY 12953-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 28/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U83350 | (02) | NY |