Provider Demographics
NPI:1063679918
Name:B TANO, M.D., P.A.
Entity Type:Organization
Organization Name:B TANO, M.D., P.A.
Other - Org Name:THE CENTER FOR ASTHMA, ALLERGY, IMMUNOLOGY & HORMONE HEALTH (TCAAIH)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:DEKI
Authorized Official - Last Name:TANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-561-9977
Mailing Address - Street 1:PO BOX 9910
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2910
Mailing Address - Country:US
Mailing Address - Phone:903-561-9977
Mailing Address - Fax:903-561-9985
Practice Address - Street 1:1404 RICE RD STE 300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3621
Practice Address - Country:US
Practice Address - Phone:903-561-9977
Practice Address - Fax:903-561-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4963207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z498Medicare PIN