Healthcare Provider Details

I. General information

NPI: 1053646711
Provider Name (Legal Business Name): JOSE R TANDOC JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15910 BRAMPTON CT
SPRING TX
77379-6646
US

IV. Provider business mailing address

15910 BRAMPTON CT
SPRING TX
77379-6646
US

V. Phone/Fax

Practice location:
  • Phone: 281-974-0371
  • Fax: 281-376-9231
Mailing address:
  • Phone: 281-974-0371
  • Fax: 281-376-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE5958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: