MEDICARE: DR. TIMOTHY LEONOR TAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	125064426	IL
2	207ZD0900X	Dermatopathology (Pathology) Physician	70062322	WA
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	02007763A	IN

General Provider Information

NPI Number	:	1205272507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY LEONOR TAN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 230457
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97281-0457
Country	:	US
Telephone Number	:	503-906-7300
Fax Number	:	503-245-8219

Provider Business Practice Location Address
First Line	:	2815 EASTLAKE AVE E STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3086
Country	:	US
Telephone Number	:	503-906-7300
Fax Number	:	503-245-8219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	11/26/2025

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