Provider Demographics
NPI:1790750933
Name:TAMARIZ, MIGUEL G (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:G
Last Name:TAMARIZ
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:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:1182 OCEAN SHORE BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-3799
Practice Address - Country:US
Practice Address - Phone:386-441-1525
Practice Address - Fax:386-441-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71654OtherBCBS
FL1790750933OtherTRICARE
FL267600100Medicaid
FL71654OtherBCBS
FL267600100Medicaid
FL71654ZMedicare ID - Type Unspecified99262B