Healthcare Provider Details

I. General information

NPI: 1710201546
Provider Name (Legal Business Name): TAMARA L. GMITTER, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MILITARY TRL SUITE 110
BOCA RATON FL
33431-6365
US

IV. Provider business mailing address

2900 N MILITARY TRL SUITE 110
BOCA RATON FL
33431-6365
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-0510
  • Fax: 561-362-1199
Mailing address:
  • Phone: 561-362-0510
  • Fax: 561-362-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0056717
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0056717
License Number StateFL

VIII. Authorized Official

Name: TAMARA L GMITTER
Title or Position: OWNER
Credential: M.D.
Phone: 561-362-0510