Individual
ALFRED JOHN REYES TANGLAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
286565
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2018
Last updated
06/23/2021
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