Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1161 | TN |
Y | 207PE0004X | Emergency Medical Services | D01194 | TN |
NPI | 1144269994 |
---|---|
Provider Name | Paul Tai-Leung Chan |
First Address | Williamsville, NY 14221-4834 |
Second Address | Williamsville, NY 14221-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 06/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1510963 | (05) | TN |
4222368 | BLUE CROSS BLUE SHIELD (01) | TN |