Individual
THANH TRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 434-1775
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS12447
FL
208M00000X
Hospitalist Physician
Primary
OS12447
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014947700
—
FL
01
—
KM236
MEDICARE
FL
Enumeration date
01/30/2014
Last updated
10/13/2023
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