Provider Demographics
NPI:1417064510
Name:TAN, CORAZON CABRERA (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:CABRERA
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORAZON
Other - Middle Name:C
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:880 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 150-B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1969
Mailing Address - Country:US
Mailing Address - Phone:770-998-0605
Mailing Address - Fax:770-587-3528
Practice Address - Street 1:880 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 150-B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1969
Practice Address - Country:US
Practice Address - Phone:770-998-0605
Practice Address - Fax:770-587-3528
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48566207Q00000X
GA036662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine