Provider Demographics
NPI:1568437689
Name:TAMAYO, RAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:E
Last Name:TAMAYO
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 1:1325 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2241
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1695
Mailing Address - Country:US
Mailing Address - Phone:407-636-9663
Mailing Address - Fax:407-636-9664
Practice Address - Street 1:1325 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2241
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1695
Practice Address - Country:US
Practice Address - Phone:407-636-9663
Practice Address - Fax:407-636-9664
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0050911OtherMEDICAL LICENSE
FL04355OtherBLUE CROSS PROVIDER #
FL061699100Medicaid
FL04355VMedicare PIN
FL061699100Medicaid