Provider Demographics
NPI:1902880198
Name:TRAN, JIM THONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:THONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 340
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8503
Practice Address - Country:US
Practice Address - Phone:904-264-4405
Practice Address - Fax:904-391-5380
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-052994207Q00000X
FLME141960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902880198OtherNPI
VA0101052994OtherVIRGINIA STATE MEDICAL LICENSE
FT2475502OtherDEA