Provider Demographics
NPI:1205831922
Name:ROY, TAPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAPAN
Middle Name:
Last Name:ROY
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 1:7330 HICKORYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-3584
Mailing Address - Country:US
Mailing Address - Phone:314-504-2009
Mailing Address - Fax:
Practice Address - Street 1:14662 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6064
Practice Address - Country:US
Practice Address - Phone:714-573-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4B372085R0001X
CAC512442085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO165953OtherBLUE CROSS PROVIDER ID
MO201528114Medicaid
MO483437OtherHEALTHLINK PROVIDER ID
MO165953OtherBLUE CROSS PROVIDER ID
MO201528114Medicaid
MOD83428Medicare UPIN