MEDICARE: CLEMENTE P NUNAG MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME89446	FL
2	207Q00000X	Family Medicine Physician	ME82024	FL
3	207R00000X	Internal Medicine Physician	ME82024	FL
4	207Q00000X	Family Medicine Physician	ME33352	FL

General Provider Information

NPI Number	:	1780645333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEMENTE P NUNAG MD PA

Provider Business Mailing Address
First Line	:	10222 YALE AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-8375
Country	:	US
Telephone Number	:	352-597-9797
Fax Number	:	352-597-5556

Provider Business Practice Location Address
First Line	:	10222 YALE AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-8375
Country	:	US
Telephone Number	:	352-597-9797
Fax Number	:	352-597-5556

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOEL MENDOZA NUNAG
Credential	:	MD
Telephone Number	:	352-597-9797

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/19/2008

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