Provider Demographics
NPI:1437227527
Name:TIMOTHY T TANG MD PA
Entity type:Organization
Organization Name:TIMOTHY T TANG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-858-4888
Mailing Address - Street 1:PO BOX 841636
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-558-9016
Mailing Address - Fax:281-558-1084
Practice Address - Street 1:17531 FM 529
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1182
Practice Address - Country:US
Practice Address - Phone:281-858-4888
Practice Address - Fax:281-858-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096301901Medicaid
TX00008BJMedicare ID - Type Unspecified
TX096301901Medicaid