Provider Demographics
NPI:1629034483
Name:VENTURA TAVARES, HUGO F (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:F
Last Name:VENTURA TAVARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUGO
Other - Middle Name:F
Other - Last Name:VENTURA TAVARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 OAKFIELD DR STE 114
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4948
Mailing Address - Country:US
Mailing Address - Phone:787-485-2914
Mailing Address - Fax:
Practice Address - Street 1:1111 OAKFIELD DR STE 114
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4948
Practice Address - Country:US
Practice Address - Phone:813-324-9899
Practice Address - Fax:813-502-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22351207R00000X
MI4301086975207R00000X
PR9351207R00000X
FLACN415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
90352Medicare ID - Type Unspecified
G02897Medicare UPIN