=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992702062
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUANG TRONG LE DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2005
-----------------------------------------------------
Last Update Date | 09/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 RIVER PARK PLZ SUITE 110
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-0920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-731-1289
-----------------------------------------------------
Fax | 817-731-1291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 RIVER PARK PLZ SUITE 110
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-0920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-731-1289
-----------------------------------------------------
Fax | 817-731-1291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L6096
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------