Individual
DR. TOMAS CORONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
F6541
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000QL64
BLUE CROSS/BLUE SHIELD
TX
05
—
120097402
—
TX
01
—
17424475170001
STATE OF TEXAS
TX
01
—
4059998
AETNA
—
01
—
742447517
TRICARE
—
Enumeration date
06/17/2006
Last updated
06/03/2014
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