Provider Demographics
NPI:1619950383
Name:SOARES, TEMITOPE F (MD)
Entity Type:Individual
Prefix:DR
First Name:TEMITOPE
Middle Name:F
Last Name:SOARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:28517 SPRING TRAILS RIDGE
Practice Address - Street 2:110
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4357
Practice Address - Country:US
Practice Address - Phone:281-385-8189
Practice Address - Fax:281-203-5037
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9017207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9073Medicare PIN
I39649Medicare UPIN