Provider Demographics
NPI:1114952835
Name:TAN, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4256 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1024
Mailing Address - Country:US
Mailing Address - Phone:713-349-0741
Mailing Address - Fax:713-490-3543
Practice Address - Street 1:3311 RICHMOND AVE STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3050
Practice Address - Country:US
Practice Address - Phone:713-401-9396
Practice Address - Fax:713-490-3543
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK6940207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044948001Medicaid
TX86657JOtherBCBS
TX86657JMedicare PIN