Healthcare Provider Details

I. General information

NPI: 1336553965
Provider Name (Legal Business Name): BRYAN TRAN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 N 26TH ST STE 106
LINCOLN NE
68521-4739
US

IV. Provider business mailing address

5315 S 80TH ST
LINCOLN NE
68516-6323
US

V. Phone/Fax

Practice location:
  • Phone: 402-826-3222
  • Fax:
Mailing address:
  • Phone: 402-575-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3432
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1190
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: