=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083722581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAMON K TAN MD DBA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6333 MAIN STREET
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-689-3905
-----------------------------------------------------
Fax | 716-689-3905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 359
-----------------------------------------------------
City | EAST AMHERST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-689-3905
-----------------------------------------------------
Fax | 716-689-3905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. RAMON K TAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 716-689-3905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 097395
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------