Healthcare Provider Details

I. General information

NPI: 1194059386
Provider Name (Legal Business Name): MINH Q TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BERT KOUN LOOP ROOM 4003
SHREVEPORT LA
71118-3119
US

IV. Provider business mailing address

2510 BERT KOUN LOOP ROOM 4003
SHREVEPORT LA
71118-3119
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5665
  • Fax: 318-212-5698
Mailing address:
  • Phone: 318-212-5665
  • Fax: 318-212-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number301810
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: