Provider Demographics
NPI:1063476356
Name:MOHAMMED, TAN LUCIEN HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAN LUCIEN
Middle Name:HASSAN
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T. LUCIEN
Other - Middle Name:
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1600 SW ARCHER RD # 100374
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0374
Practice Address - Country:US
Practice Address - Phone:352-265-0291
Practice Address - Fax:352-265-0279
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-05802085R0202X
OH350847722085R0202X
FLME1205802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0299743OtherLABOR & INDUSTRY
OH2517208Medicaid
WA1063476356Medicaid
FL012305300Medicaid
WAMD00123OtherAK DSHS
WAP01121104OtherRAILROAD MEDICARE
OH2517208Medicaid
FL012305300Medicaid
WA8911809Medicare PIN
OHH80750Medicare UPIN
WA8912232Medicare PIN