Provider Demographics
NPI:1295815983
Name:GMITTER, TAMARA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LEE
Last Name:GMITTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-362-0510
Mailing Address - Fax:561-362-1199
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-362-0510
Practice Address - Fax:561-362-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME056717207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE86677Medicare UPIN
FL12331Medicare ID - Type Unspecified