Provider Demographics
NPI:1528066495
Name:TIAN, GANG GARY (MD)
Entity type:Individual
Prefix:MR
First Name:GANG
Middle Name:GARY
Last Name:TIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7945 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6701
Practice Address - Street 1:7945 WOLF RIVER BOULEVARD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-922-6701
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18163207RH0003X
ARE3740207RH0003X
TN37455207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4156741OtherTN BCBS
TN41026OtherTLC
TN3000362Medicaid
AR5M939OtherAR BCBS
TN9265094OtherCIGNA
MS00407367Medicaid
AR159905001Medicaid
TN7176524OtherAETNA
MO208389015Medicaid
MS00407367Medicaid
AR159905001Medicaid
TN41026OtherTLC
TN3000362Medicaid