Provider Demographics
NPI:1053646711
Name:TANDOC, JOSE R JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:TANDOC
Suffix:JR
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 1:15910 BRAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6646
Mailing Address - Country:US
Mailing Address - Phone:281-974-0371
Mailing Address - Fax:281-376-9231
Practice Address - Street 1:15910 BRAMPTON CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6646
Practice Address - Country:US
Practice Address - Phone:281-974-0371
Practice Address - Fax:281-376-9231
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE5958208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC22472Medicare UPIN