Individual
DOMINGO K TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6100 HARRIS PARKWAY, SUITE 270, FORT WORTH, TX 76132-4132
(817) 433-5658
(817) 570-0173
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 570-0173
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H0872
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020054588
RAILROAD MEDICARE
—
05
—
113676406
—
TX
Enumeration date
07/17/2006
Last updated
12/31/2015
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