Provider Demographics
NPI:1023026309
Name:HOTAN, TANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIE
Middle Name:
Last Name:HOTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:AUMSVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97325-0139
Mailing Address - Country:US
Mailing Address - Phone:503-749-4734
Mailing Address - Fax:503-749-3745
Practice Address - Street 1:205 MAIN ST.
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9018
Practice Address - Country:US
Practice Address - Phone:503-749-4734
Practice Address - Fax:503-749-3745
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287200Medicaid
ORR110353Medicare ID - Type Unspecified
OR287200Medicaid