Provider Demographics
NPI:1093805046
Name:TANG, TIMOTHY T (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:T
Last Name:TANG
Suffix:
Gender:M
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 841636
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-1636
Mailing Address - Country:US
Mailing Address - Phone:281-858-4888
Mailing Address - Fax:281-858-4846
Practice Address - Street 1:17531 FM 529 RD #100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-858-4888
Practice Address - Fax:281-858-4846
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K4659OtherMEDICARE INDIVIDUAL PTAN
TX096301901Medicaid
G05450Medicare UPIN
TX096301901Medicaid