Provider Demographics
NPI:1366419590
Name:TRAN, DAVID DUONG (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUONG
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:PO BOX 1373
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1373
Mailing Address - Country:US
Mailing Address - Phone:985-400-5483
Mailing Address - Fax:985-400-5493
Practice Address - Street 1:121 LAKEVIEW CIR
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7513
Practice Address - Country:US
Practice Address - Phone:985-400-5483
Practice Address - Fax:985-400-5493
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1482200Medicaid
LA110217952OtherRAILROAD MEDICARE
LA5DN50Medicare UPIN
LA1482200Medicaid