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General NPI Number Information
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NPI Number | 1457300758
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Entity Type | Individual
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Provider Name | EDWARD H TAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 612 NOLANA ST
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City | MCALLEN
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State | TX
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Zip | 78504-3088
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Country | US
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Telephone | 956-630-2225
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Fax | 956-630-2275
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Provider Business Mailing Address
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Address Line | PO BOX 720010
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City | MCALLEN
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State | TX
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Zip | 78504-0010
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Country | US
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Telephone | 956-630-2225
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Fax | 956-630-2275
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | J5034
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License Number State | TX
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