MEDICARE: DR. GEORGE TAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A103328	CA
2	207RG0100X	Gastroenterology Physician	20694	NV

General Provider Information

NPI Number	:	1205071677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE TAN M.D.

Provider Business Mailing Address
First Line	:	5119 CAMINO AL NORTE STE 100
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2373
Country	:	US
Telephone Number	:	702-625-8989
Fax Number	:	702-331-3115

Provider Business Practice Location Address
First Line	:	5119 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2373
Country	:	US
Telephone Number	:	702-625-8989
Fax Number	:	702-331-3115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	11/28/2023

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