Provider Demographics
NPI:1043905490
Name:JEREMIAH-TANG, DANIEL J (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:JEREMIAH-TANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:ZAMORA-JEREMIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4502 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2536
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2536
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program