Provider Demographics
NPI:1578601712
Name:TAN, LOURDES R (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:R
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:215 MORRIS AVENUE
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550
Mailing Address - Country:US
Mailing Address - Phone:785-628-6987
Mailing Address - Fax:785-628-1438
Practice Address - Street 1:208 EAST 7 STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-1438
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSMD04197382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B91227Medicare UPIN
KS017991Medicare ID - Type Unspecified