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General NPI Number Information
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NPI Number | 1942315866
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Entity Type | Organization
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Legal Business Name | PE THAN TIN MD PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 930 OAK ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2410
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Country | US
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Telephone | 423-266-7392
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Fax |
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Provider Business Mailing Address
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Address Line | 930 OAK ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2410
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Country | US
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Telephone | 423-266-7392
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PE THAN TIN
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Credential | MD
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Telephone | 706-866-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD0000011136
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License Number State | TN
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