Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | C1-0012097 | DE |
Y | 207XS0106X | Orthopaedic Hand Surgeon | C1-0012097 | DE |
NPI | 1336434570 |
---|---|
Provider Name | Tiffany June-Tien Pan |
First Address | Newark, DE 19702-3358 |
Second Address | Dover, DE 19904-7801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 05/10/2018 |