Provider Demographics
NPI:1083652598
Name:D'SOUZA, TAMMY C (DO)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:C
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 UNION ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5007
Mailing Address - Country:US
Mailing Address - Phone:407-518-5004
Mailing Address - Fax:407-643-9343
Practice Address - Street 1:701 UNION ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5007
Practice Address - Country:US
Practice Address - Phone:407-518-5004
Practice Address - Fax:407-643-9343
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13362207QA0505X, 207Q00000X
WAOP00001702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0170091OtherLABOR AND INDUSTRIES
WA9838DSOtherREGENCE RIDER
WA8256414Medicaid
WA8934629OtherLABOR AND INDUSTRIES VOC
WAP00108793OtherMEDICARE RAIL ROAD
WA7450165OtherAETNA
WAH02594Medicare UPIN
WAAB38165Medicare ID - Type Unspecified