Provider Demographics
NPI:1336467059
Name:TIRNAUER, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:TIRNAUER
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 1:4400 W SPRUCE ST APT 138
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4152
Mailing Address - Country:US
Mailing Address - Phone:727-743-9379
Mailing Address - Fax:
Practice Address - Street 1:10010 N DALE MABRY HWY STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4469
Practice Address - Country:US
Practice Address - Phone:727-743-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN14640207R00000X
FLTRN232602085N0700X
FLME1330332085N0700X
FLME01330332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXDVO2OtherBLUE CROSS BLUE SHIELD
VA15296065000696OtherPECOS DCN
FL103873100Medicaid