Provider Demographics
NPI:1275533713
Name:TINGUELY, ROY (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:TINGUELY
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 1:95 S PAGOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8329
Mailing Address - Country:US
Mailing Address - Phone:970-731-3700
Mailing Address - Fax:
Practice Address - Street 1:95 S PAGOSA BLVD
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8329
Practice Address - Country:US
Practice Address - Phone:970-731-3700
Practice Address - Fax:970-731-2362
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0125153Medicaid
IA19614OtherIOWA HEALTH SOLUTIONS
IA51645OtherBLUE CROSS
IA020026976OtherRAILROAD MEDICARE
IAIA0106OtherJOHN DEERE HEALTH
IA51645OtherBLUE CROSS
IAG10693Medicare UPIN