Basic Information
| Provider Information | |||||||||
| NPI: | 1790895118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VO | ||||||||
| FirstName: | TRANG | ||||||||
| MiddleName: | THI THU | ||||||||
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| Credential: | RD LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035314262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FV3375056 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | R1148 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 8GM895 | 01 | TX | BCBS | OTHER | 370890102 | 05 | TX | MEDICAID | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 370890101 | 05 | TX | MEDICAID | 370890104 | 01 | TX | BCBS | OTHER | P01811992 | 01 | TX | MEDICARE RAIL ROAD | OTHER | 370890103 | 05 | TX | MEDICAID | 8GM894 | 01 | TX | BCBS | OTHER | P01793346 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 75-0818167-044 | 01 | TX | TRICARE | OTHER | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 75-0818167-048 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8GM896 | 01 | TX | BCBS | OTHER | 8GM897 | 01 | TX | BCBS | OTHER | P01811494 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 75-1976930-005 | 01 | TX | TRICARE | OTHER |