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General NPI Number Information
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NPI Number | 1154825156
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Entity Type | Individual
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Provider Name | MERRICK BRADLEY TAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 10/14/2023
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Provider Practice Location Address
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Address Line | 3600 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94611-5730
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Country | US
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Telephone | 510-406-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 3138 CHIMNEY CT
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City | UNION CITY
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State | CA
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Zip | 94587-1650
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Country | US
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Telephone | 510-717-3489
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A165891
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License Number State | CA
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