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1346303088 NPI number — L TAN MD LC

NPI Number: 1346303088
Health Care Provider/Practitioner: L TAN MD LC

Information about “1346303088” NPI (L TAN MD LC) exists in 1346303088 in HTML format HTML  |  1346303088 in plain Text format TXT  |  1346303088 in PDF (Portable Document Format) PDF  |  1346303088 in an XML format XML  formats.

NPI Number : 1346303088 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346303088",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "L TAN MD LC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2915 MADISON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARIANNA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32446-3449",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2915 MADISON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARIANNA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32446-3449",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-536-2460",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2006",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TAN",
    "AuthorizedOfficialFirstName": "L",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MGR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "904-537-0954",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208800000X",
        "TaxonomyName": "Urology Physician",
        "LicenseNumber": "ME339964",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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