Alfonso Oliva Tan, MD
Individual provider Active NPI Internal Medicine Physician · Winchester, OR
NPI 1407085210 · NPPES record last updated Jul 14, 2009
Key facts
- NPI
- 1407085210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD13317 (OR)
- Practice address
- 305 Thora Circle Dr.
Winchester, OR 97495 - Phone
- (541) 673-4516
- NPI assigned
- Jul 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD13317 | OR | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD13317 | OR | Yes |
Addresses
Primary practice location
305 Thora Circle Dr.
Winchester, OR 97495
Mailing address
PO Box 534
Winchester, OR 97495-0534
Phone (541) 673-4516
Other providers in Winchester, OR
All providers in Winchester, OR · Internal Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.