Provider Demographics
NPI:1215972336
Name:TRAN, DAN NICOLAS (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:NICOLAS
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1290 WATERMAN WAY STE 1290
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5229
Mailing Address - Country:US
Mailing Address - Phone:352-742-0054
Mailing Address - Fax:352-742-2103
Practice Address - Street 1:1290 WATERMAN WAY STE 1290
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5229
Practice Address - Country:US
Practice Address - Phone:352-742-0054
Practice Address - Fax:352-742-2103
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92816208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272836200Medicaid
I06674Medicare UPIN
FL11021OtherBCBS