Provider Demographics
NPI:1366670408
Name:TANYOUS, WALID F (MD)
Entity Type:Individual
Prefix:DR
First Name:WALID
Middle Name:F
Last Name:TANYOUS
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 1:425 NURSING HOME DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3839
Mailing Address - Country:US
Mailing Address - Phone:863-993-2966
Mailing Address - Fax:863-494-5491
Practice Address - Street 1:435 COMMERCIAL CT
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1658
Practice Address - Country:US
Practice Address - Phone:941-559-0262
Practice Address - Fax:941-375-8569
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126550207RC0200X, 207RS0012X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018192100Medicaid