Provider Demographics
NPI:1104104207
Name:TRAN, THO VAN (MD)
Entity type:Individual
Prefix:
First Name:THO
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2000
Mailing Address - Country:US
Mailing Address - Phone:713-449-1668
Mailing Address - Fax:
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2000
Practice Address - Country:US
Practice Address - Phone:713-449-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP72202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry