MEDICARE: HUI TANG M.D.

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	207Q00000X	Family Medicine Physician	ME85064	FL
2	2083X0100X	Occupational Medicine Physician	ME85064	FL

General Provider Information

NPI Number	:	1649275488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUI TANG M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	10131 SAN JOSE BLVD STE 24
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5857
Country	:	US
Telephone Number	:	904-337-2055
Fax Number	:	904-337-2056

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	06/21/2022

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