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General NPI Number Information
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NPI Number | 1396785903
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Entity Type | Individual
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Provider Name | TANYA JAN PITTMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 555 W 15TH ST
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City | LIBERAL
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State | KS
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Zip | 67901-2461
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Country | US
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Telephone | 620-624-0702
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Fax | 620-624-3402
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Provider Business Mailing Address
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Address Line | 315 W 15TH ST
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City | LIBERAL
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State | KS
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Zip | 67901-2455
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Country | US
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Telephone | 620-624-1651
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Fax | 620-629-2472
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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 | 425369
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License Number State | KS
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