MEDICARE: DR. RAOUL I TAMAYO MD

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	208M00000X	Hospitalist Physician	13020	NV
2	207R00000X	Internal Medicine Physician	13020	NV

General Provider Information

NPI Number	:	1053371369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAOUL I TAMAYO MD

Provider Business Mailing Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2329
Country	:	US
Telephone Number	:	702-207-8263
Fax Number	:	702-207-8256

Provider Business Practice Location Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2329
Country	:	US
Telephone Number	:	702-207-8253
Fax Number	:	702-207-8256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/30/2024

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