Provider Demographics
NPI:1831197417
Name:TAPANGAN, ROSSELLER B (MD)
Entity type:Individual
Prefix:
First Name:ROSSELLER
Middle Name:B
Last Name:TAPANGAN
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 1:2710 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8616
Mailing Address - Country:US
Mailing Address - Phone:956-399-9300
Mailing Address - Fax:
Practice Address - Street 1:2710 EMERALD LAKE DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8616
Practice Address - Country:US
Practice Address - Phone:956-399-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043238703Medicaid
TX043238703Medicaid