Healthcare Provider Details

I. General information

NPI: 1205272507
Provider Name (Legal Business Name): TIMOTHY LEONOR TAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 EASTLAKE AVE E STE 240
SEATTLE WA
98102-3086
US

IV. Provider business mailing address

PO BOX 230457
PORTLAND OR
97281-0457
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-7300
  • Fax: 503-245-8219
Mailing address:
  • Phone: 503-906-7300
  • Fax: 503-245-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125064426
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number70062322
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number02007763A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: