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General NPI Number Information
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NPI Number | 1063919702
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Entity Type | Individual
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Provider Name | BERNADETTE ANNE LIM TAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 315 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4234
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Country | US
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Telephone | 253-403-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3039 HICKORY RIDGE CIR
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City | BRYAN
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State | TX
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Zip | 77807
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Country | US
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Telephone | 979-324-9220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T1232
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License Number State | TX
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