Provider Demographics
NPI:1457300758
Name:TAN, EDWARD H (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
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:PO BOX 720010
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0010
Mailing Address - Country:US
Mailing Address - Phone:956-630-2225
Mailing Address - Fax:956-630-2275
Practice Address - Street 1:612 NOLANA ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3088
Practice Address - Country:US
Practice Address - Phone:956-630-2225
Practice Address - Fax:956-630-2275
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ50342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071EYOtherBLUE CROSS
TX131136703Medicaid
TX8F23844OtherMEDICARE
TX8F23844OtherMEDICARE