Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 6062 | OK |
Y | 111NI0900X | Internist | 6062 | OK |
NPI | 1003203662 |
---|---|
Provider Name | Thao Tran |
First Address | Tulsa, OK 74135-2512 |
Second Address | Tulsa, OK 74135-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 07/04/2017 |