MEDICARE: JOSE A QUIMBAYO M D P A

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	207R00000X	Internal Medicine Physician	ME0063746	FL

General Provider Information

NPI Number	:	1902936024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE A QUIMBAYO M D P A

Provider Business Mailing Address
First Line	:	3201 W WATERS AVE SUITE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614
Country	:	US
Telephone Number	:	813-915-0055
Fax Number	:	813-931-1552

Provider Business Practice Location Address
First Line	:	3201 W WATERS AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2879
Country	:	US
Telephone Number	:	813-915-0055
Fax Number	:	813-931-1552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE ALFONSO QUIMBAYO
Credential	:	M,D
Telephone Number	:	813-915-0055

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/25/2007

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