Healthcare Provider Details

I. General information

NPI: 1235768409
Provider Name (Legal Business Name): ALICE DANG TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6099
US

IV. Provider business mailing address

PO BOX 6048
BEND OR
97708-6048
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-4900
  • Fax:
Mailing address:
  • Phone: 541-382-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD217342
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: