Basic Information
| Provider Information | |||||||||
| NPI: | 1255325528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARANGO | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8637 FREDERICKSBURG RD | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106174029 | ||||||||
| FaxNumber: | 2106174075 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N YARBROUGH DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799153240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155951844 | ||||||||
| FaxNumber: | 9155991953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G6029 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0976797 | 05 | TX | MEDICAID | TXB130415 | 01 | TX | WELLMED | OTHER | 83A747 | 01 | TX | BLUE CROSS | OTHER | 4211791 | 01 | TX | AETNA | OTHER |