Provider Demographics
NPI:1780725549
Name:QUIMBAYO, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:QUIMBAYO
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 1:3201 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2879
Mailing Address - Country:US
Mailing Address - Phone:813-915-0055
Mailing Address - Fax:813-931-1552
Practice Address - Street 1:3201 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2879
Practice Address - Country:US
Practice Address - Phone:813-915-0055
Practice Address - Fax:813-931-1552
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372622300Medicaid
FLBQ2113570OtherDEA
FL18671WMedicare PIN
FLBQ2113570OtherDEA