Provider Demographics
NPI:1215944087
Name:TRAN, NGOC-PHUONG THI (DO)
Entity type:Individual
Prefix:
First Name:NGOC-PHUONG
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LIZ NGOCPHUONG
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, PA
Mailing Address - Street 1:1611 OHLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-873-7173
Mailing Address - Fax:512-835-9334
Practice Address - Street 1:1611 OHLEN ROAD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-873-7173
Practice Address - Fax:512-835-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114956901Medicaid
TX74-2464431OtherTAX ID
TX00H46MMedicare PIN
TX74-2464431OtherTAX ID