Provider Demographics
NPI:1821291188
Name:INTERNAL MEDICINE, PRIMARY CARE ASSOCIATES OF SOUTH FLORIDA, P.A.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE, PRIMARY CARE ASSOCIATES OF SOUTH FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:I
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-940-0522
Mailing Address - Street 1:301 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2304
Mailing Address - Country:US
Mailing Address - Phone:305-940-0522
Mailing Address - Fax:305-653-1138
Practice Address - Street 1:301 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2304
Practice Address - Country:US
Practice Address - Phone:305-940-0522
Practice Address - Fax:305-653-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258494800Medicaid
FL258494800Medicaid
FLG29745Medicare UPIN