Healthcare Provider Details

I. General information

NPI: 1417985300
Provider Name (Legal Business Name): FEDERICO P ILANG-ILANG JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E. FLORIDA ST.
MIDLAND TX
79701-6357
US

IV. Provider business mailing address

413 ACADIA LN
FORNEY TX
75126-4221
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-0450
  • Fax: 432-685-0458
Mailing address:
  • Phone: 469-438-4493
  • Fax: 972-289-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG0620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: