Provider Demographics
NPI:1447396726
Name:DANIEL T.L. TAN, M.D., P.A.
Entity Type:Organization
Organization Name:DANIEL T.L. TAN, M.D., P.A.
Other - Org Name:SPECTRUM PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T L
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-779-4200
Mailing Address - Street 1:10101 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1126
Mailing Address - Country:US
Mailing Address - Phone:713-779-4200
Mailing Address - Fax:713-779-5866
Practice Address - Street 1:10101 SOUTHWEST FWY
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1126
Practice Address - Country:US
Practice Address - Phone:713-779-4200
Practice Address - Fax:713-779-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ32412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132061602Medicaid
TX10017070OtherAMERIGROUP MEDICAID #
TX00T54FMedicare ID - Type Unspecified
TX10017070OtherAMERIGROUP MEDICAID #