Individual
STEPHEN R TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-7580
(651) 254-7584
Mailing address
401 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-7580
(651) 254-7584
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
44614
MN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
44614
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064221500
—
MN
Enumeration date
02/16/2006
Last updated
08/14/2020
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