Individual
DR. FREDERICK S TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 E 29TH ST, STE 117, BRYAN, TX 77802-2618
(979) 774-3960
(979) 774-4506
Mailing address
2801 E 29TH ST, STE 117, BRYAN, TX 77802-2618
(979) 774-3960
(979) 774-4506
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
K8511
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017GC
BLUE CROSS BLUE SHILED
—
01
—
390007453
RAILROAD MEDICARE
—
Enumeration date
07/26/2006
Last updated
02/02/2012
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