Individual
DAN-TAM THI TRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14810 OLD SAINT AUGUSTINE RD, SUITE 106, JACKSONVILLE, FL 32258
(904) 268-7701
(904) 268-9708
Mailing address
14810 OLD SAINT AUGUSTINE RD, SUITE 106, JACKSONVILLE, FL 32258-2451
(904) 268-7701
(904) 268-9708
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME93753
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010756200
—
FL
Enumeration date
05/02/2006
Last updated
10/27/2021
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