=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477589844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NGUYET ANH TRAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 12/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 RIDGE ST SUITE 102
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51503-4643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-396-7890
-----------------------------------------------------
Fax | 712-396-7895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2797
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68103-2797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-354-4230
-----------------------------------------------------
Fax | 402-354-6171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number | 23309
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------