Healthcare Provider Details

I. General information

NPI: 1053818286
Provider Name (Legal Business Name): IGAL TARASH DO MD EMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

IV. Provider business mailing address

1966 TICE VALLEY BLVD # 112
WALNUT CREEK CA
94595-2203
US

V. Phone/Fax

Practice location:
  • Phone: 903-877-7168
  • Fax: 903-877-8356
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS6538
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: