Provider Demographics
NPI:1912088089
Name:TRAN, HOA THI MAI
Entity type:Individual
Prefix:
First Name:HOA
Middle Name:THI MAI
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 E STATE HIGHWAY 76 STE A
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7511
Mailing Address - Country:US
Mailing Address - Phone:417-334-5864
Mailing Address - Fax:417-334-4978
Practice Address - Street 1:875 E STATE HIGHWAY 76 STE A
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-334-5864
Practice Address - Fax:417-334-4978
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004022194OtherPHYSICIAN ASST. LICENSE