Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME34199 | FL |
NPI | 1033167473 |
---|---|
Provider Name | Uldarico Badiongan Tan |
First Address | Chattahoochee, FL 32324-2230 |
Second Address | Chattahoochee, FL 32324-2230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |