Provider Demographics
NPI:1508031170
Name:WILLIAM TEJEIRO M D PA
Entity Type:Organization
Organization Name:WILLIAM TEJEIRO M D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-5661
Mailing Address - Street 1:PO BOX 430106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0106
Mailing Address - Country:US
Mailing Address - Phone:305-642-5661
Mailing Address - Fax:305-642-5664
Practice Address - Street 1:3899 NW 7TH ST
Practice Address - Street 2:#200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5551
Practice Address - Country:US
Practice Address - Phone:305-642-5661
Practice Address - Fax:305-642-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058822261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4581380002Medicare NSC