Provider Demographics
NPI:1548601057
Name:TIRO, ALLAN CABRERA (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:CABRERA
Last Name:TIRO
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 1:1721 VIA LAGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810
Mailing Address - Country:US
Mailing Address - Phone:863-272-3990
Mailing Address - Fax:
Practice Address - Street 1:1721 VIA LAGO DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2371
Practice Address - Country:US
Practice Address - Phone:863-272-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024158E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery