Healthcare Provider Details

I. General information

NPI: 1003141383
Provider Name (Legal Business Name): WOODLANDS MEDICAL SPECIALISTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 E JOHNSON AVE SUITE 100
PENSACOLA FL
32514-6036
US

IV. Provider business mailing address

4724 N DAVIS HWY
PENSACOLA FL
32503-2339
US

V. Phone/Fax

Practice location:
  • Phone: 850-475-2230
  • Fax: 850-434-2647
Mailing address:
  • Phone: 850-696-4000
  • Fax: 850-434-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS B TAN
Title or Position: PRES
Credential: M D
Phone: 850-696-4000