Provider Demographics
NPI:1396785903
Name:PITTMAN, TANYA JAN (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:JAN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:J
Other - Last Name:PITTMAN NAVARETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:315 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2455
Mailing Address - Country:US
Mailing Address - Phone:620-624-1651
Mailing Address - Fax:620-629-2472
Practice Address - Street 1:555 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2461
Practice Address - Country:US
Practice Address - Phone:620-624-0702
Practice Address - Fax:620-624-3402
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS425369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100193090MMedicaid
KS100193090GMedicaid
KSP01031314OtherRAILROAD MCARE
104272Medicare PIN
KA1209012Medicare PIN
KSP01031314OtherRAILROAD MCARE
KS100193090MMedicaid