Provider Demographics
NPI:1285621490
Name:TAN, GUBERT LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GUBERT
Middle Name:LEE
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:
Practice Address - Street 1:222 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2138
Practice Address - Country:US
Practice Address - Phone:419-526-1964
Practice Address - Fax:419-526-0012
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360884532084N0400X
OH350746602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072813Medicaid
G80316Medicare UPIN
OHH264581Medicare PIN