Healthcare Provider Details

I. General information

NPI: 1427194240
Provider Name (Legal Business Name): JEANETTE TAN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 GATEWAY BLVD E STE 200
EL PASO TX
79915-1803
US

IV. Provider business mailing address

7812 GATEWAY BLVD E STE 200
EL PASO TX
79915-1803
US

V. Phone/Fax

Practice location:
  • Phone: 915-592-6868
  • Fax: 915-592-6889
Mailing address:
  • Phone: 915-592-6868
  • Fax: 915-592-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberJ9375
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ9375
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberJ9375
License Number StateTX

VIII. Authorized Official

Name: JEANETTE TAN
Title or Position: PRESIDENT
Credential: MD
Phone: 915-592-6868