Basic Information
| Provider Information | |||||||||
| NPI: | 1821304163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | COLLEEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 MOUNTAIN VIEW DR | ||||||||
| Address2: | PO BOX 1668 | ||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604261611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 MOUNTAIN VIEW DR | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604261611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2010 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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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 | 207P00000X | OP60464034 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.