Healthcare Provider Details

I. General information

NPI: 1265421770
Provider Name (Legal Business Name): TRUC CHINH TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 SPRING CENTRE SOUTH BLVD STE 1020
ALTAMONTE SPRINGS FL
32714-5000
US

IV. Provider business mailing address

1175 SPRING CENTRE SOUTH BLVD STE 1020
ALTAMONTE SPRINGS FL
32714-5000
US

V. Phone/Fax

Practice location:
  • Phone: 321-221-8522
  • Fax: 407-297-9801
Mailing address:
  • Phone: 321-221-8522
  • Fax: 407-297-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME38008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: