Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OS8364 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 088364 | FL |
N | 207ND0900X | Dermatopathologist | 088364 | FL |
N | 207NS0135X | Procedural Dermatology | 088364 | FL |
NPI | 1437117116 |
---|---|
Provider Name | Thi Thien Tran |
First Address | The Villages, FL 32162-5602 |
Second Address | The Villages, FL 32162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 18/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10197 | (02) |