Provider Demographics
NPI:1538366729
Name:GO, JORGE TAN (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:TAN
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 VERNON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-751-6667
Mailing Address - Fax:513-872-4553
Practice Address - Street 1:2925 VERNON PL STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2425
Practice Address - Country:US
Practice Address - Phone:513-751-6667
Practice Address - Fax:513-872-4553
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37291207R00000X, 207RG0100X, 208M00000X
OH35132137207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71701OtherWELLMARK BLUE SHIELD
IAP00433925OtherRAILROAD MEDICARE
IA71305OtherWELLMARK BCBS
IA70633OtherWELLMARK BLUE SHIELD
IAP00433925OtherRAILROAD MEDICARE
IA70633OtherWELLMARK BLUE SHIELD
IAI20906Medicare PIN