Provider Demographics
NPI:1649249483
Name:TAN, CLARIBEL K (MD)
Entity type:Individual
Prefix:
First Name:CLARIBEL
Middle Name:K
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:PO BOX 240985
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-0985
Mailing Address - Country:US
Mailing Address - Phone:907-929-1859
Mailing Address - Fax:907-929-7859
Practice Address - Street 1:2401 E 42ND AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-929-1859
Practice Address - Fax:907-929-7859
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5689207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD7787Medicaid
AK7787Medicaid
AKMD7787Medicaid
G19691Medicare UPIN
AKK 160412Medicare PIN