Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K6940 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | K6940 | TX |
NPI | 1114952835 |
---|---|
Provider Name | Robert S Tan |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86657J | BCBS (01) | TX |
G92263 | (02) | TX |