Healthcare Provider Details

I. General information

NPI: 1609211572
Provider Name (Legal Business Name): TRUNG LY TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN STE 210
ROGERS AR
72758-1456
US

IV. Provider business mailing address

2708 S RIFE MEDICAL LN STE 210
ROGERS AR
72758-1456
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3888
  • Fax: 479-338-4453
Mailing address:
  • Phone: 479-338-3888
  • Fax: 479-338-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number42553
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberE-16230
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: