Basic Information
| Provider Information | |||||||||
| NPI: | 1164701983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANDY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BARRANCA DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799355004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155913130 | ||||||||
| FaxNumber: | 9155913136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 BARRANCA DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799355004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155913130 | ||||||||
| FaxNumber: | 9155913136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 08/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.