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General NPI Number Information
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NPI Number | 1437456225
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Entity Type | Organization
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Legal Business Name | SALLY Q TAN MD PC
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 1110 N CLASSEN BLVD SUITE 204
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6843
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Country | US
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Telephone | 405-319-1622
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Fax | 405-319-1575
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Provider Business Mailing Address
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Address Line | 1110 N CLASSEN BLVD SUITE 204
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6843
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Country | US
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Telephone | 405-319-1622
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Fax | 405-319-1575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALLY Q. TAN
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Credential | M.D.
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Telephone | 405-319-1622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19992
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License Number State | OK
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