Provider Demographics
NPI:1619389020
Name:TAN, GRACE X (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:X
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8510
Mailing Address - Fax:503-494-4631
Practice Address - Street 1:1200 HILYARD ST STE 620
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8157
Practice Address - Country:US
Practice Address - Phone:458-205-6500
Practice Address - Fax:458-205-6453
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD201443207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology