Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | ME112876 | FL |
Y | 2081P2900X | Pain Medicine | ME112876 | FL |
NPI | 1104017391 |
---|---|
Provider Name | Dr. Huaiyu Tan |
First Address | Pensacola, FL 32522-7567 |
Second Address | Pensacola, FL 32501-6339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005930000 | (05) | FL |