Provider Demographics
NPI:1417939018
Name:HAHN, TARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:HAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:613 ELIZABETH ST STE 809
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2232
Mailing Address - Country:US
Mailing Address - Phone:361-883-3831
Mailing Address - Fax:361-887-0146
Practice Address - Street 1:613 ELIZABETH ST STE 809
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2232
Practice Address - Country:US
Practice Address - Phone:361-883-3831
Practice Address - Fax:361-887-0146
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0423208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172277901Medicaid
TXH69790Medicare UPIN
TX172277901Medicaid