Provider Demographics
NPI:1649257486
Name:CORDOVEZ-TAN, MARIAN E (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:E
Last Name:CORDOVEZ-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 1:3220 CENTRAL MALL DR.
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642
Mailing Address - Country:US
Mailing Address - Phone:409-729-7900
Mailing Address - Fax:409-727-5277
Practice Address - Street 1:3220 CENTRAL MALL DR.
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-729-7900
Practice Address - Fax:409-727-5277
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8970174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG15826Medicare UPIN