Individual
EL-CID O TAJON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Mailing address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3401
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179363003
—
TX
01
—
82557Y
BLUE CROSS BLUE SHIELD
TX
01
—
P00335607
RAIL ROAD MEDICARE
TX
Enumeration date
07/11/2006
Last updated
02/12/2013
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