Provider Demographics
NPI:1811193766
Name:TAN, DANIEL TL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TL
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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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
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2013-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ32412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132061602Medicaid
TXF71451Medicare UPIN
TX00T54FMedicare ID - Type Unspecified