Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME54721 | FL |
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME54721 | FL |
NPI | 1104885789 |
---|---|
Provider Name | Dr. Lukas H Tan |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 07/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3704947-00 | (05) | FL |
975031480A | (05) | GA |
F33582 | (02) | FL |