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Individual

THOMAS B TAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
400 MEDICAL PLZ STE 100, LAKE ST LOUIS, MO 63367-1493
(636) 639-8600
Mailing address
4724 N DAVIS HWY, PENSACOLA, FL 32503-2339
(850) 696-4000
(850) 434-2647

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
17614
AL
207RH0003X
Hematology & Oncology Physician
Primary
2020008924
MO
207RH0003X
Hematology & Oncology Physician
62467
FL
207RX0202X
Medical Oncology Physician
H2823
TX
207RX0202X
Medical Oncology Physician
MD221267
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
109896
AL MEDICAID- FOLEY
AL
01
110883
AL MEDICAID- N DAVIS
AL
01
110905
AL MEDICAID- WEST FLORIDA OFFICE
AL
05
371163300
FL
Enumeration date
09/14/2005
Last updated
03/03/2025
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