Provider Demographics
NPI:1992908297
Name:DANG, GERALD TRIMINH HUY (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:TRIMINH HUY
Last Name:DANG
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 1:995 S YATES RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0882
Mailing Address - Country:US
Mailing Address - Phone:901-527-7100
Mailing Address - Fax:
Practice Address - Street 1:995 S YATES RD
Practice Address - Street 2:STE. 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0882
Practice Address - Country:US
Practice Address - Phone:901-527-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42380208800000X
MS19806208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09350075Medicaid
TN3000256Medicaid
MSP00405464OtherRAILROAD MEDICARE
MSP00405464OtherRAILROAD MEDICARE
TN3000256Medicaid