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General NPI Number Information
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NPI Number | 1710179445
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Entity Type | Organization
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Legal Business Name | MARIAN TAN MEDICAL GROUP LTD LLP
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 3220 CENTRAL MALL DRIVE
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City | PORT ARTHUR
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State | TX
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Zip | 77642
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Country | US
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Telephone | 409-729-7900
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Fax | 409-727-5277
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Provider Business Mailing Address
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Address Line | 3220 CENTRAL MALL DRIVE
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City | PORT ARTHUR
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State | TX
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Zip | 77642
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Country | US
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Telephone | 409-729-7900
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Fax | 409-727-5277
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. MARIAN E CORDOVEZ-TAN
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Credential | MD
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Telephone | 409-729-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J9870
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License Number State | TX
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