Organization
SIMON S TAN, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON SY TAN MD (PRESIDENT)
(817) 488-0100
Entity
Organization
Contact information
Practice address
731 E SOUTHLAKE BLVD STE 170, SOUTHLAKE, TX 76092-6382
(817) 488-0100
(817) 488-4568
Mailing address
3600 WILLIAM D TATE AVE, SUITE 200, GRAPEVINE, TX 76051-8723
(817) 488-0100
(817) 488-4568
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
L2023
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001JA
BCBS
TX
05
—
151996901
—
TX
Enumeration date
08/19/2006
Last updated
10/22/2018
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