Provider Demographics
NPI:1336125046
Name:JALIL, TANIA Q (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:Q
Last Name:JALIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1474 W PRICE RD # 536
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8687
Mailing Address - Country:US
Mailing Address - Phone:956-350-5530
Mailing Address - Fax:956-350-5527
Practice Address - Street 1:4920 N EXPRESSWAY
Practice Address - Street 2:ALTON GLOOR PLAZA #101
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4121
Practice Address - Country:US
Practice Address - Phone:956-350-5530
Practice Address - Fax:956-350-5527
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118627604Medicaid
TX8V8540OtherBLUE CROSS & BLUE SHIELD
TX116839OtherSUPERIOR HEALTH PLANS
TX8V8540OtherBLUE CROSS & BLUE SHIELD