Provider Demographics
NPI:1407072788
Name:B TANO, MD PA
Entity Type:Organization
Organization Name:B TANO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:DEKI
Authorized Official - Last Name:TANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-4336
Mailing Address - Street 1:2106 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0964
Mailing Address - Country:US
Mailing Address - Phone:903-581-0096
Mailing Address - Fax:
Practice Address - Street 1:4407 BEE CAVE RD STE 122
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6001
Practice Address - Country:US
Practice Address - Phone:512-338-4336
Practice Address - Fax:512-330-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4963207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty