=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639247125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAN N. TRAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3909 LAPALCO BLVD STE 200
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-349-6216
-----------------------------------------------------
Fax | 504-347-6210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3625 RED OAK CT
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70131-8425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-391-1180
-----------------------------------------------------
Fax | 504-347-6210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD.13319R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------