1780674838 NPI number — THEODORE W YAREMO M.D., P.A.

Table of content: THEODORE W YAREMO M.D., P.A. (NPI 1780674838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780674838 NPI number — THEODORE W YAREMO M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAREMO
Provider First Name:
THEODORE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YAREMO
Provider Other First Name:
THEODORE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780674838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33951-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-637-6380
Provider Business Mailing Address Fax Number:
941-347-8244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W MCKENZIE ST STE 117
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33950-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-637-6062
Provider Business Practice Location Address Fax Number:
941-575-4449
Provider Enumeration Date:
10/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME49299 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74616 . This is a "BCBS GROUP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 05918 . This is a "BCBS INDIVIDUAL #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".