Provider Demographics
NPI:1871935288
Name:THAN, TIN MYO (MD)
Entity type:Individual
Prefix:DR
First Name:TIN
Middle Name:MYO
Last Name:THAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3949 EVANS AVE
Mailing Address - Street 2:204
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9335
Mailing Address - Country:US
Mailing Address - Phone:239-939-2428
Mailing Address - Fax:239-433-1269
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:204
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9335
Practice Address - Country:US
Practice Address - Phone:239-939-2428
Practice Address - Fax:239-433-1269
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME263832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry