Provider Demographics
NPI:1336101450
Name:AMOAH, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:AMOAH
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:PO BOX 47023
Mailing Address - Street 2:#3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0109
Mailing Address - Country:US
Mailing Address - Phone:813-948-5810
Mailing Address - Fax:813-948-5212
Practice Address - Street 1:27455 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6901
Practice Address - Country:US
Practice Address - Phone:813-948-5810
Practice Address - Fax:813-948-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268830100Medicaid
FLG41841Medicare UPIN
FL268830100Medicaid