Provider Demographics
NPI:1134296171
Name:TAN, ALFONSO III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:TAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-835-1246
Mailing Address - Fax:716-835-0396
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-835-1246
Practice Address - Fax:716-835-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2178722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry