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NPI Code Detail

MEDICARE: JEANETTE TAN M.D.

MEDICARE: JEANETTE 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
1174400000XSpecialistJ9375TX

General Provider Information

NPI Number : 1518938810
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANETTE TAN M.D.
Provider Business Mailing Address
First Line : 7806 GATEWAY BLVD E
Second Line : SUITE 100
City : EL PASO
State : TX
Zip : 79915-1806
Country : US
Telephone Number : 915-592-6868
Fax Number : 915-592-6889
Provider Business Practice Location Address
First Line : 7806 GATEWAY BLVD E
Second Line : SUITE 100
City : EL PASO
State : TX
Zip : 79915-1806
Country : US
Telephone Number : 915-592-6868
Fax Number : 915-592-6889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 02/05/2008

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