Provider Demographics
NPI:1730127580
Name:TANDY, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:TANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 W HIGHWAY 6
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5575
Mailing Address - Country:US
Mailing Address - Phone:254-776-7744
Mailing Address - Fax:254-751-9211
Practice Address - Street 1:601 W HIGHWAY 6
Practice Address - Street 2:SUITE 106
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5575
Practice Address - Country:US
Practice Address - Phone:254-776-7744
Practice Address - Fax:254-751-9211
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2988207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120566801Medicaid
TXTA0823445Medicare ID - Type Unspecified
TX120566801Medicaid