Individual
CORNELIA W. TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
303 E OVERTON RD, DALLAS, TX 75216-5946
(214) 266-4200
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
J2363
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139120302
—
TX
05
—
139120303
—
TX
05
—
139120304
—
TX
05
—
139120305
—
TX
05
—
139120306
—
TX
05
—
139120307
—
TX
05
—
139120308
—
TX
05
—
139120309
—
TX
05
—
139120310
—
TX
05
—
139120312
—
TX
05
—
139120313
—
TX
05
—
139120314
—
TX
Enumeration date
08/02/2005
Last updated
12/04/2012
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