Healthcare Provider Details

I. General information

NPI: 1689454548
Provider Name (Legal Business Name): PCTRAN PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W PARKER RD STE 220
PLANO TX
75093-8178
US

IV. Provider business mailing address

6020 W PARKER RD STE 220
PLANO TX
75093-8178
US

V. Phone/Fax

Practice location:
  • Phone: 214-360-7430
  • Fax: 214-617-0440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PHU C. TRAN
Title or Position: CEO
Credential: MD
Phone: 214-360-7430