Provider Demographics
NPI:1992888226
Name:ARISTORENAS, JUAN TAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:TAN
Last Name:ARISTORENAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0311
Mailing Address - Country:US
Mailing Address - Phone:731-632-3373
Mailing Address - Fax:731-632-9335
Practice Address - Street 1:135 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-0311
Practice Address - Country:US
Practice Address - Phone:731-632-3373
Practice Address - Fax:731-632-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00008527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3158065Medicaid
TN3158065Medicare ID - Type Unspecified
TN3158065Medicaid