Provider Demographics
NPI:1033171517
Name:TAMAYO, VICTOR I (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:I
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2304
Mailing Address - Country:US
Mailing Address - Phone:305-940-0522
Mailing Address - Fax:305-653-1138
Practice Address - Street 1:301 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2304
Practice Address - Country:US
Practice Address - Phone:305-940-0522
Practice Address - Fax:305-653-1138
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258494800Medicaid
FLG29745Medicare UPIN
FL46488AMedicare PIN