Healthcare Provider Details

I. General information

NPI: 1275667271
Provider Name (Legal Business Name): TRUC TRUNG LY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 VILLAGE DR SUITE 608
SAN ANTONIO TX
78217-5405
US

IV. Provider business mailing address

8711 VILLAGE DR SUITE 114
SAN ANTONIO TX
78217-5418
US

V. Phone/Fax

Practice location:
  • Phone: 210-798-4311
  • Fax: 210-798-4318
Mailing address:
  • Phone: 210-798-4311
  • Fax: 210-798-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR1238
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberR1238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: