Provider Demographics
NPI:1508025412
Name:TANTUCO, IRVIN CO (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:CO
Last Name:TANTUCO
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 1:1213 HERMANN DR STE 610
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7012
Mailing Address - Country:US
Mailing Address - Phone:713-524-3900
Mailing Address - Fax:713-527-8356
Practice Address - Street 1:1213 HERMANN DR STE 610
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7012
Practice Address - Country:US
Practice Address - Phone:713-524-3900
Practice Address - Fax:713-527-8356
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAABIM282060207RS0012X
TXN0497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196517001Medicaid
TX8L0948Medicare PIN