1265572028 NPI number — RAUL E TAMAYO P L

Table of content: (NPI 1265572028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265572028 NPI number — RAUL E TAMAYO P L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAUL E TAMAYO P L
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADULT MEDICINE SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265572028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 WEKIVA SPRINGS RD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32779-5946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-460-5722
Provider Business Mailing Address Fax Number:
407-389-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 WEKIVA SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32779-5946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-460-5722
Provider Business Practice Location Address Fax Number:
407-389-2273
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAMAYO
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
407-788-2273

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0050911 , 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: 0601699100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265572028 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "DR. TAMAYO SOCIAL SEC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 72774 . This is a "GROUP BCBS NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1568437689 . This is a "DR. TAMAYO NPI NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 04355 . This is a "DR TAMAYO BCBS INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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