Provider Demographics
NPI:1801892401
Name:TAFUR, ANGEL E (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:E
Last Name:TAFUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1503 BUENOS AIRES BLVD
Mailing Address - Street 2:BUILDING106
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6821
Mailing Address - Country:US
Mailing Address - Phone:352-350-6241
Mailing Address - Fax:352-350-6249
Practice Address - Street 1:1503 BUENOS AIRES BLVD
Practice Address - Street 2:BUILDING106
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6821
Practice Address - Country:US
Practice Address - Phone:352-350-6241
Practice Address - Fax:352-350-6249
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42606OtherBCBS
FLG58866Medicare UPIN
FLK8849Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #
FLE0035YMedicare ID - Type UnspecifiedINDIVIDUAL MC PROVIDER #