Individual
KENNETH SHU-WEN TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3217 S PROVIDENCE RD, COLUMBIA, MO 65203-3639
(573) 884-7733
(573) 882-6228
Mailing address
3217 S PROVIDENCE RD, COLUMBIA, MO 65203-3639
(573) 884-7733
(573) 882-6228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012020842
MO
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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