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NPI Code Detail

MEDICARE: PETER BUNLEE TAN CRNA

MEDICARE: PETER BUNLEE TAN CRNA
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
1367500000XCertified Registered Nurse Anesthetist1225826TX
2163W00000XRegistered Nurse947104TX

General Provider Information

NPI Number : 1366315467
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER BUNLEE TAN CRNA
Provider Business Mailing Address
First Line : PO BOX 840853
Second Line :
City : DALLAS
State : TX
Zip : 75284-0853
Country : US
Telephone Number : 972-233-1999
Fax Number : 972-233-3666
Provider Business Practice Location Address
First Line : 12222 MERIT DR STE 600
Second Line :
City : DALLAS
State : TX
Zip : 75251-3294
Country : US
Telephone Number : 972-715-5000
Fax Number : 972-715-9976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2025
Last Update Date : 03/03/2026

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Directions to “ PETER BUNLEE TAN CRNA” Practice Location

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