Healthcare Provider Details

I. General information

NPI: 1760829113
Provider Name (Legal Business Name): TAMARA JOHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 3RD CT STE 5
PLANTATION FL
33317-2830
US

IV. Provider business mailing address

PO BOX 121041
FORT LAUDERDALE FL
33312-0009
US

V. Phone/Fax

Practice location:
  • Phone: 954-551-4508
  • Fax: 800-507-3145
Mailing address:
  • Phone: 954-551-4508
  • Fax: 800-507-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME148725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: