1700869229 NPI number — DR. RAYMUNDO T TAN M.D.

Table of content: DR. RAYMUNDO T TAN M.D. (NPI 1700869229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700869229 NPI number — DR. RAYMUNDO T TAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAN
Provider First Name:
RAYMUNDO
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700869229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 5TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58401-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-252-1050
Provider Business Mailing Address Fax Number:
701-952-3265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 5TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-1050
Provider Business Practice Location Address Fax Number:
701-952-3265
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4669 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18514 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01008891 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16-11656 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7207820 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47607 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13243 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 46031641458401C003 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 719609 . This is a "AMERICA'S PPO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com