Provider Demographics
NPI:1104857127
Name:TAN, THOO H (DO)
Entity Type:Individual
Prefix:
First Name:THOO
Middle Name:H
Last Name:TAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 4TH ST SW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2857
Mailing Address - Country:US
Mailing Address - Phone:641-428-5100
Mailing Address - Fax:641-428-5115
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 220
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-428-5100
Practice Address - Fax:641-428-5115
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG04921Medicare UPIN