Provider Demographics
NPI:1669658860
Name:ANGELYN TARRANT, MD, PA
Entity Type:Organization
Organization Name:ANGELYN TARRANT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELYN
Authorized Official - Middle Name:LENELL
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-328-2333
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:SUITE C-104
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-328-2333
Mailing Address - Fax:512-328-2359
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE C-104
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-328-2333
Practice Address - Fax:512-328-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8292Medicare PIN