Healthcare Provider Details

I. General information

NPI: 1497034136
Provider Name (Legal Business Name): DAVID TANG MD, FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE CAMPUS BOX 8238
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

4555 FOREST PARK AVE APT A503
SAINT LOUIS MO
63108-2177
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2011020144
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: