MEDICARE: DR PETER TRAN DO LC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699809293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PETER TRAN DO LC

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	:	702-363-3288

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	:	702-363-3288

Authorized Official
Title or Position	:	OWNER-PHYSICIAN
Name	:	DR. PETER ANH TRAN
Credential	:	D.O.
Telephone Number	:	702-363-3288

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	05/10/2013

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