=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710391099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVIN TRAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2014
-----------------------------------------------------
Last Update Date | 09/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 HENNESSY BLVD STE 4000
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-766-7441
-----------------------------------------------------
Fax | 225-766-7597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 HENNESSY BLVD STE 4000
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-769-9637
-----------------------------------------------------
Fax | 225-769-6343
-----------------------------------------------------
=====================================================
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 | 312198
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------