Provider Demographics
NPI:1023146230
Name:TAVAREZ, HIRAM (MD)
Entity type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:
Last Name:TAVAREZ
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 1:801 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-686-0574
Mailing Address - Fax:956-686-3301
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-686-0574
Practice Address - Fax:956-686-3301
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7783174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351024YLPSOtherWELLMED PTAN
TX114287905Medicaid
TX114287905Medicaid