Healthcare Provider Details

I. General information

NPI: 1457300758
Provider Name (Legal Business Name): EDWARD H TAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 NOLANA ST
MCALLEN TX
78504-3088
US

IV. Provider business mailing address

PO BOX 720010
MCALLEN TX
78504-0010
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-2225
  • Fax: 956-630-2275
Mailing address:
  • Phone: 956-630-2225
  • Fax: 956-630-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ5034
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: