MEDICARE: DR. BAO TRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	L2705	TX
2	208D00000X	General Practice Physician	L2705	TX

General Provider Information

NPI Number	:	1366549750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAO TRAN

Provider Business Mailing Address
First Line	:	3904 KINGSFERRY CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-3623
Country	:	US
Telephone Number	:	817-478-3533
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 KINGSFERRY CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-3623
Country	:	US
Telephone Number	:	817-478-3533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/20/2007

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