Healthcare Provider Details

I. General information

NPI: 1881666006
Provider Name (Legal Business Name): JAMES A TAMMARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/03/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 1 S
ST AUGUSTINE FL
32084-4211
US

IV. Provider business mailing address

1400 US HIGHWAY 1 S
ST AUGUSTINE FL
32084-4211
US

V. Phone/Fax

Practice location:
  • Phone: 904-484-7356
  • Fax: 904-679-3727
Mailing address:
  • Phone: 904-484-7356
  • Fax: 904-679-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number90743
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME136050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: