Healthcare Provider Details

I. General information

NPI: 1811959729
Provider Name (Legal Business Name): JOHN VAN TRAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN PHUC VAN TRAN D.P.M.

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 EICHENFELD DR SUITE 108
BRANDON FL
33511-5985
US

IV. Provider business mailing address

505 EICHENFELD DR SUITE 108
BRANDON FL
33511-5985
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-6922
  • Fax: 813-685-8308
Mailing address:
  • Phone: 813-685-6922
  • Fax: 813-685-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3132
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO3132
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: