Healthcare Provider Details

I. General information

NPI: 1104809946
Provider Name (Legal Business Name): RAYMOND CHARLES TAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 N CEDAR AVE
FRESNO CA
93720-2685
US

IV. Provider business mailing address

PO BOX 756
DANVILLE CA
94526-0756
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-1000
  • Fax: 559-437-3870
Mailing address:
  • Phone: 877-866-0914
  • Fax: 916-303-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA73252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: