Individual
DR. ETHAN TRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26338 73RD AVE FL 2, GLEN OAKS, NY 11004-1004
(408) 600-4490
Mailing address
26338 73RD AVE FL 2, GLEN OAKS, NY 11004-1004
(408) 600-4490
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
261208-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518258268
TRICARE SOUTH
TX
05
—
302201401
—
TX
05
—
302201402
—
TX
01
—
8DG075
BCBS
TX
Enumeration date
04/29/2011
Last updated
06/28/2013
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