Provider Demographics
NPI:1689212516
Name:TIRADO BIENTZ, JORGE IMAE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:IMAE
Last Name:TIRADO BIENTZ
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 1:9501 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1252
Mailing Address - Country:US
Mailing Address - Phone:813-413-7333
Mailing Address - Fax:813-563-4530
Practice Address - Street 1:9501 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1252
Practice Address - Country:US
Practice Address - Phone:813-413-7333
Practice Address - Fax:813-563-4530
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine