Provider Demographics
NPI:1275528382
Name:TAN, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:TAN
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 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-434-2647
Practice Address - Street 1:RAPID CITY REGIONAL HOSPITAL
Practice Address - Street 2:353 FAIRMONT BLVD.
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:850-232-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17614207RH0003X
TXH2823207RX0202X
FL62467207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL109896OtherAL MEDICAID- FOLEY
AL110883OtherAL MEDICAID- N DAVIS
FL371163300Medicaid
AL110905OtherAL MEDICAID- WEST FLORIDA OFFICE
FL17847YMedicare PIN
FL371163300Medicaid