Healthcare Provider Details

I. General information

NPI: 1306824651
Provider Name (Legal Business Name): TOM ALLEN TARKENTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 26TH AVE STE A
MINERAL WELLS TX
76067-8248
US

IV. Provider business mailing address

220 SW 26TH AVE STE A
MINERAL WELLS TX
76067-8248
US

V. Phone/Fax

Practice location:
  • Phone: 940-325-1543
  • Fax: 940-325-2679
Mailing address:
  • Phone: 940-325-1543
  • Fax: 940-325-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ4552
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ4552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: