Organization
L TAN MD LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L TAN (MGR)
(904) 537-0954
Entity
Organization
Contact information
Practice address
2915 MADISON ST, MARIANNA, FL 32446-3449
(850) 536-2460
Mailing address
2915 MADISON ST, MARIANNA, FL 32446-3449
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME339964
FL
Other
Enumeration date
12/17/2006
Last updated
08/22/2020
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