Healthcare Provider Details

I. General information

NPI: 1275594897
Provider Name (Legal Business Name): ANTHONY HOANG TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E HIBISCUS BLVD
MELBOURNE FL
32901-3102
US

IV. Provider business mailing address

111 E HIBISCUS BLVD
MELBOURNE FL
32901-3102
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-3655
  • Fax: 321-831-3024
Mailing address:
  • Phone: 321-768-3655
  • Fax: 321-831-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT8070
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-01012
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME95316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: