L TAN MD LC
Urology at Madison St, Marianna, FL

License number
Florida ME339964
Category
Radiology
Type
Urology
Owner
Name: L TAN
Title: MGR
Phone: (904) 537-0954
Address
Address
2915 Madison St, Marianna, FL 32446
National Provider ID: 1346303088
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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L TAN MD LC

2915 Madison St, Marianna, FL 32446

Registration:
Dec 11, 2003
State ID:
L03000052148
Business type:
Florida Limited Liability Company
L Tan, 2915 Madison St, Marianna, FL 32446 (Physical)
Agent:
Tan, L,2915 Madison St, Marianna, FL 32446 (Physical)
FEI/EIN:
20-0474825

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