Antique, Daisy Tan

Antique, Daisy Tan is an individual health care provider with primary practice located at 708 W Forest Ave , Jackson TN 38301-3901. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Antique, Daisy Tan can be contacted via phone (731) 660-8759.

Contact Information

Primary practice address
708 W Forest Ave Jackson TN 38301-3901
Phone: (731) 660-8759
Fax: (731) 660-8739
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 39516 Tennessee

Profile Details

NPI number 1447227939
LBN Legal business name Antique, Daisy Tan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2006
Last updated Dec 11th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447227939 NPPES
Other P00364407 RR MEDICARE
MEDICAID 3337042 RR MEDICARE
Other 4118140 RR MEDICARE

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