Healthcare Provider Details

I. General information

NPI: 1649989237
Provider Name (Legal Business Name): ANJANETTE TAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 HARRIS PKWY STE 300
FT WORTH TX
76132-4301
US

IV. Provider business mailing address

6844 HARRIS PKWY STE 300
FORT WORTH TX
76132-4301
US

V. Phone/Fax

Practice location:
  • Phone: 817-263-0007
  • Fax: 817-263-1118
Mailing address:
  • Phone: 817-263-0007
  • Fax: 817-263-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: ANJANETTE TAN
Title or Position: PRESIDENT
Credential: MD
Phone: 817-263-0007