Provider Demographics
NPI:1427411644
Name:TRAN, JIMMY TAM (DO)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:TAM
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 WOLF RIVER BLVD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-767-5000
Mailing Address - Fax:901-767-6000
Practice Address - Street 1:7550 WOLF RIVER BLVD.
Practice Address - Street 2:STE. 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-767-5000
Practice Address - Fax:901-767-6000
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2019-08-16
Deactivation Date:2019-06-24
Deactivation Code:
Reactivation Date:2019-07-15
Provider Licenses
StateLicense IDTaxonomies
TN3457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine