Provider Demographics
NPI:1710201546
Name:TAMARA L. GMITTER, MD PA
Entity Type:Organization
Organization Name:TAMARA L. GMITTER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GMITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-362-0510
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-362-0510
Mailing Address - Fax:561-362-1199
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-362-0510
Practice Address - Fax:561-362-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056717207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12331Medicare PIN