Individual
DONGFENG TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M4579
TX
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
FTL 40611
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170688901
—
TX
05
—
182739601 (MDACC)
—
TX
01
—
8F2334
BCBS
TX
01
—
8S2502
BCBS (MDACC)
TX
01
—
P00347956
RR MEDICARE (MDACC)
TX
Enumeration date
06/02/2006
Last updated
07/27/2012
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