Provider Demographics
NPI:1306474697
Name:TAMAYO, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N BRYAN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6293
Mailing Address - Country:US
Mailing Address - Phone:956-540-2588
Mailing Address - Fax:888-355-6407
Practice Address - Street 1:409 N BRYAN RD STE 106
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6293
Practice Address - Country:US
Practice Address - Phone:956-540-2588
Practice Address - Fax:888-355-6407
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0859207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine