Provider Demographics
NPI:1780741181
Name:EDWARD H TAN M D P A
Entity type:Organization
Organization Name:EDWARD H TAN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-2225
Mailing Address - Street 1:PO BOX 720010
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0010
Mailing Address - Country:US
Mailing Address - Phone:956-630-2225
Mailing Address - Fax:956-630-2275
Practice Address - Street 1:612 NOLANA ST STE 330
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3088
Practice Address - Country:US
Practice Address - Phone:956-630-2225
Practice Address - Fax:956-630-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131136703Medicaid
TX0A5858OtherMEDICARE ID