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NPI Code Detail

MEDICARE: EDISON N TAN M.D.

MEDICARE: EDISON N 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
1207R00000XInternal Medicine PhysicianME78501FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
149390OTHERBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962475533
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDISON N TAN M.D.
Provider Business Mailing Address
First Line : 1840 N HIGHLAND AVE
Second Line :
City : CLEARWATER
State : FL
Zip : 33755-2138
Country : US
Telephone Number : 727-442-3001
Fax Number : 727-467-9106
Provider Business Practice Location Address
First Line : 1840 N HIGHLAND AVE
Second Line :
City : CLEARWATER
State : FL
Zip : 33755-2138
Country : US
Telephone Number : 727-442-3001
Fax Number : 727-467-9106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 02/04/2008

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