Healthcare Provider Details

I. General information

NPI: 1972595106
Provider Name (Legal Business Name): EPISON TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

425 LEWIS HARGETT CIR
LEXINGTON KY
40503-3590
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-3288
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24748
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: