# L TAN MD LC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346303088
- **Authorized official:** L TAN (MGR)
- **Authorized official phone:** (904) 537-0954

## Contact information

- **Practice address:** 2915 MADISON ST, MARIANNA, FL 32446-3449
- **Practice address phone:** (850) 536-2460
- **Mailing address:** 2915 MADISON ST, MARIANNA, FL 32446-3449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | ME339964 | FL | Yes |
| 208D00000X | General Practice Physician | ME339964 | FL | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 12/17/2006
- **Last updated:** 07/18/2026