Provider Demographics
NPI:1750352258
Name:TAN, EUGENE PO (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:PO
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8245 COUNTY ROAD 44 LEG A
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3751
Mailing Address - Country:US
Mailing Address - Phone:352-326-3366
Mailing Address - Fax:352-326-3533
Practice Address - Street 1:8245 COUNTY ROAD 44 LEG A
Practice Address - Street 2:SUITE 2
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3751
Practice Address - Country:US
Practice Address - Phone:352-326-3366
Practice Address - Fax:352-326-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-07-07
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Provider Licenses
StateLicense IDTaxonomies
FLME66420208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375528200Medicaid
FL375528200Medicaid
KYE55250Medicare UPIN