Provider Demographics
NPI:1275528382
Name:TAN, THOMAS B (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:TAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-434-2647
Practice Address - Street 1:400 MEDICAL PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1493
Practice Address - Country:US
Practice Address - Phone:636-639-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17614207RH0003X
FL62467207RH0003X
ORMD221267207RX0202X
TXH2823207RX0202X
MO2020008924207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371163300Medicaid
AL109896OtherAL MEDICAID- FOLEY
AL110883OtherAL MEDICAID- N DAVIS
AL110905OtherAL MEDICAID- WEST FLORIDA OFFICE
FL17847YMedicare PIN
FL371163300Medicaid