Provider Demographics
NPI:1114024080
Name:TANGEL, DOUGLAS JOAQUIM (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOAQUIM
Last Name:TANGEL
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 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3178
Mailing Address - Country:US
Mailing Address - Phone:303-651-5302
Mailing Address - Fax:
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-651-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28054207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280544Medicaid
CO01280544Medicaid