MEDICARE: ANGEL ANAEL TEJADA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R8122	TX

General Provider Information

NPI Number	:	1982085205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL ANAEL TEJADA MD

Provider Business Mailing Address
First Line	:	7737 SOUTHWEST FWY STE 415
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1800
Country	:	US
Telephone Number	:	713-988-0653
Fax Number	:	713-988-8903

Provider Business Practice Location Address
First Line	:	7737 SOUTHWEST FWY STE 415
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1800
Country	:	US
Telephone Number	:	713-988-0653
Fax Number	:	713-988-8903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	05/24/2022

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