Healthcare Provider Details

I. General information

NPI: 1568033728
Provider Name (Legal Business Name): PETER TRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243 FAIRMONT PKWY STE 104
PASADENA TX
77505-4046
US

IV. Provider business mailing address

6243 FAIRMONT PKWY STE 104
PASADENA TX
77505-4046
US

V. Phone/Fax

Practice location:
  • Phone: 832-402-7856
  • Fax: 713-904-3071
Mailing address:
  • Phone: 832-402-7856
  • Fax: 713-904-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: