Provider Demographics
NPI:1083603989
Name:YAMAMURA, KENNETH H (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:YAMAMURA
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 1:13601 BRUCE B DOWNS BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4694
Mailing Address - Country:US
Mailing Address - Phone:813-971-2424
Mailing Address - Fax:813-971-2420
Practice Address - Street 1:13601 BRUCE B DOWNS BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4694
Practice Address - Country:US
Practice Address - Phone:813-971-2424
Practice Address - Fax:813-971-2420
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67414207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
27664OtherBLUE CROSS BLUE SHIELD
FL378229800Medicaid
2336752OtherAETNA
6506906001OtherCIGNA
2500783OtherUNITED HEALTH CARE
270614OtherAVMED
2336752OtherAETNA
6506906001OtherCIGNA