Provider Demographics
NPI:1306978853
Name:ATTILA, TAN (MD)
Entity type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:ATTILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATATURK CADDESI NO 55 DILKUM BLOK 5 DAIRE 46
Mailing Address - Street 2:
Mailing Address - City:SAHRAYI CEDID
Mailing Address - State:ISTANBUL
Mailing Address - Zip Code:34734
Mailing Address - Country:TR
Mailing Address - Phone:90216-363-6931
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8417
Practice Address - Fax:503-494-5339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27206207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology