Provider Demographics
NPI:1992702062
Name:LE, QUANG TRONG (DO)
Entity type:Individual
Prefix:DR
First Name:QUANG
Middle Name:TRONG
Last Name:LE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2550 RIVER PARK PLZ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0920
Mailing Address - Country:US
Mailing Address - Phone:817-731-1289
Mailing Address - Fax:817-731-1291
Practice Address - Street 1:2550 RIVER PARK PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0920
Practice Address - Country:US
Practice Address - Phone:817-731-1289
Practice Address - Fax:817-731-1291
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL6096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168554701Medicaid
TX168554701Medicaid
TX8C8147Medicare PIN