Individual
TONY TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4835 S DURANGO DR, LAS VEGAS, NV 89147-8171
(702) 877-5199
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 877-8600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0310
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972998391
—
NV
Enumeration date
04/02/2015
Last updated
06/07/2016
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