Healthcare Provider Details

I. General information

NPI: 1932603313
Provider Name (Legal Business Name): ALAN TRUONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

2605 WATERSTONE LN
ROCKWALL TX
75032-6848
US

V. Phone/Fax

Practice location:
  • Phone: 601-296-3963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU2344
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: