Healthcare Provider Details

I. General information

NPI: 1679066021
Provider Name (Legal Business Name): JIMMY TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E 41ST ST STE 900
TULSA OK
74135-5631
US

IV. Provider business mailing address

5801 E 41ST ST STE 900
TULSA OK
74135-5631
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-8838
  • Fax: 918-743-8552
Mailing address:
  • Phone: 918-743-8838
  • Fax: 918-743-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33901
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.148350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: