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NPI Code Detail

MEDICARE: EDMUNDO RAFAEL TAMAYO M.D.

MEDICARE: EDMUNDO RAFAEL TAMAYO M.D.
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
1207R00000XInternal Medicine PhysicianME67715FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457347957
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDMUNDO RAFAEL TAMAYO M.D.
Provider Business Mailing Address
First Line : 9037 BISCAYNE BOULEVARD
Second Line :
City : MIAMI
State : FL
Zip : 33138-3221
Country : US
Telephone Number : 305-835-2797
Fax Number : 305-835-6228
Provider Business Practice Location Address
First Line : 1190 NW 95TH ST
Second Line : SUITE 107
City : MIAMI
State : FL
Zip : 33150-2063
Country : US
Telephone Number : 305-835-2797
Fax Number : 305-835-6228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 08/03/2017

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Directions to “ EDMUNDO RAFAEL TAMAYO M.D.” Practice Location

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