Provider Demographics
NPI:1801849542
Name:TADURAN, VIRGILIO M (MD)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:M
Last Name:TADURAN
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0009
Mailing Address - Country:US
Mailing Address - Phone:620-649-2771
Mailing Address - Fax:620-649-2538
Practice Address - Street 1:410 CHEYENNE STREET
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-0009
Practice Address - Country:US
Practice Address - Phone:620-649-2771
Practice Address - Fax:620-649-2538
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS41716OtherBLUE CROSS-HOSPITAL
KS04-17676OtherSTATE LICENSE #
KS100139460BMedicaid
KS41397OtherBLUE SHIELD-SATANTA
KS100139460BMedicaid