Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 28240 | TX |
Y | 213EG0000X | General Practice | 28240 | TX |
NPI | 1003162934 |
---|---|
Provider Name | Dr. Jeff S Tan |
First Address | Lewisville, TX 75067-3716 |
Second Address | Lewisville, TX 75067-3516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 30/07/2012 |