Organization
FREDERICK S TAN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK TAN (MD)
(979) 775-9483
Entity
Organization
Contact information
Practice address
1705 E 29TH ST, BRYAN, TX 77802-1406
(979) 775-9483
(979) 775-9557
Mailing address
1705 E 29TH ST, BRYAN, TX 77802-1406
(979) 775-9483
(979) 775-9557
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
TX
Enumeration date
03/10/2007
Last updated
08/22/2020
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