Provider Demographics
NPI:1497813588
Name:TAN, STELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3808
Mailing Address - Country:US
Mailing Address - Phone:806-934-7839
Mailing Address - Fax:806-934-7836
Practice Address - Street 1:224 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3808
Practice Address - Country:US
Practice Address - Phone:806-934-7839
Practice Address - Fax:806-934-7836
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126264105OtherFIRSTCARE GROUP NUMBER
TX855450OtherBCBS GROUP NUMBER
TX096253203Medicaid
TX00593KMedicare PIN
TX855450OtherBCBS GROUP NUMBER
TXP00289493Medicare ID - Type UnspecifiedMEDICARE RAILROAD GROUP