Provider Demographics
NPI:1255325528
Name:TARANGO, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:TARANGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1219
Mailing Address - Country:US
Mailing Address - Phone:210-617-4029
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:501 N YARBROUGH DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3240
Practice Address - Country:US
Practice Address - Phone:915-595-1844
Practice Address - Fax:915-599-1953
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0976797Medicaid
TXTXB130415OtherWELLMED
TX83A747OtherBLUE CROSS
TX4211791OtherAETNA
B26866Medicare UPIN
TX00G940Medicare ID - Type Unspecified