Individual
DR. LUKAS H TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, UFJP NEONATOLOGY, JACKSONVILLE, FL 32209-6511
(904) 244-4254
(904) 244-4301
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME54721
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME54721
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3704947-00
—
FL
05
—
975031480A
—
GA
Enumeration date
03/21/2006
Last updated
08/07/2019
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