Basic Information
| Provider Information | |||||||||
| NPI: | 1174978233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOLLEN IRIZARRY | ||||||||
| FirstName: | MISAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 E MORRISON RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785263316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563896565 | ||||||||
| FaxNumber: | 9563896567 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 E MORRISON RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564357705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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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 | 208D00000X | 19195 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | S2919 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.