Provider Demographics
NPI:1063528453
Name:PANGILINAN, TRISTAN HULAR (MD)
Entity type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:HULAR
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TRISTAN
Other - Middle Name:
Other - Last Name:TRISTAN PANGILINAN, MD, FACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 NE 19TH DR
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1932
Mailing Address - Country:US
Mailing Address - Phone:863-467-7666
Mailing Address - Fax:863-467-1087
Practice Address - Street 1:200 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-467-7666
Practice Address - Fax:863-467-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME053071208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0053071OtherFL DEPT OF HEALTH
FL0486582-00Medicaid
FL0486582-00Medicaid
07245Medicare ID - Type Unspecified