MEDICARE: DR. PETER A TRAN IV DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	1188	NV

General Provider Information

NPI Number	:	1598762353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A TRAN IV DO

Provider Business Mailing Address
First Line	:	1776 W HORIZON RIDGE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89012-5018
Country	:	US
Telephone Number	:	702-363-3288
Fax Number	:	702-363-0788

Provider Business Practice Location Address
First Line	:	1776 W HORIZON RIDGE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89012-5018
Country	:	US
Telephone Number	:	702-363-3288
Fax Number	:	702-363-0788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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