Most Relevant Information
Provider Data
| NPI Number: | 1003201005 |
| Provider Name: | ELISE TRAN D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/06/2015 |
| Last Updated: | 03/02/2022 |
Provider Practice Location
1545 E SOUTHLAKE BLVD STE 100
SOUTHLAKE
TX
760926465
Practice Location Phone/Fax
| Phone: | 8174429300 |
| Fax: | 8174160108 |
Provider Mailing Location
1545 E SOUTHLAKE BLVD STE 100
SOUTHLAKE
TX
760926465
Provider Mailing Phone/Fax
| Phone: | 8174429300 |
| Fax: | 8174160108 |