Provider Demographics
NPI:1629323118
Name:VIERRA, TARA PHILLIPP (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:PHILLIPP
Last Name:VIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5111 N 10TH ST
Mailing Address - Street 2:#112
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2835
Mailing Address - Country:US
Mailing Address - Phone:956-631-9739
Mailing Address - Fax:956-631-6717
Practice Address - Street 1:5111 N 10TH ST
Practice Address - Street 2:#112
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2835
Practice Address - Country:US
Practice Address - Phone:956-631-9739
Practice Address - Fax:956-631-6717
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2020-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP9274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338892805Medicaid