Provider Demographics
NPI:1174698070
Name:TAN, MANUEL NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:NELSON
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3309 SW 34TH CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3392
Mailing Address - Country:US
Mailing Address - Phone:352-237-0509
Mailing Address - Fax:352-237-9808
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-237-0509
Practice Address - Fax:352-237-9808
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME83892207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME83892OtherWC PROVDR
FL15739OtherBCBS PRVDR
FL592689712OtherUHC PRVDR
FL264793100Medicaid
FLN146227OtherHLTHEZ WC
FL264793100Medicaid
FLME83892OtherWC PROVDR
FLH66794Medicare UPIN