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General NPI Number Information
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NPI Number | 1487729323
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Entity Type | Organization
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Legal Business Name | NORTHSIDE DOCTORS, P.A.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 920 MEDICAL PLAZA DRIVE SUITE 360
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City | SHENANDOAH
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State | TX
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Zip | 77380-3271
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Country | US
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Telephone | 281-719-0483
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Fax | 281-719-0756
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Provider Business Mailing Address
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Address Line | 920 MEDICAL PLAZA DRIVE SUITE 360
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City | SHENANDOAH
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State | TX
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Zip | 77380-3271
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Country | US
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Telephone | 281-719-0483
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Fax | 281-719-0756
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DUYEN MY TRAN
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Credential | M.D.
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Telephone | 281-719-0483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L7582
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | L7582
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License Number State | TX
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