Provider Demographics
NPI:1104017391
Name:TAN, HUAIYU (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HUAIYU
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD, PHD
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 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 530
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0028968207RA0000X
FLME112876208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005930000Medicaid
FL14L6AOtherFLORIDA BLUE (BCBS OF FL)
AL592-17625OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL139657Medicaid
AL592-17624OtherBLUE CROSS BLUE SHIELD OF ALABAMA
FL005930000Medicaid
AL592-17624OtherBLUE CROSS BLUE SHIELD OF ALABAMA