Provider Demographics
NPI:1992794341
Name:TRAN, HAI ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:HAI
Middle Name:ANTHONY
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:ANTHONY
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:5510 COWHORN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9101
Mailing Address - Country:US
Mailing Address - Phone:903-831-4673
Mailing Address - Fax:903-831-4672
Practice Address - Street 1:5510 COWHORN CREEK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-9101
Practice Address - Country:US
Practice Address - Phone:903-831-4673
Practice Address - Fax:903-831-4672
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ55002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222760AMedicaid
AR96943OtherBCBS
AR125767001Medicaid
AR90303900040OtherQUAL CHOICE OF ARKANSAS
TX034993801Medicaid
OK100222760AMedicaid
920006424OtherRAILROAD MEDICARE
TX920006424OtherRAILROAD MEDICARE
TXF12050Medicare UPIN
AR125767001Medicaid