Provider Demographics
NPI:1881725935
Name:TAMAR, KYRON C (MD)
Entity type:Individual
Prefix:DR
First Name:KYRON
Middle Name:C
Last Name:TAMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4680
Mailing Address - Country:US
Mailing Address - Phone:813-933-9666
Mailing Address - Fax:813-932-9229
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-933-9666
Practice Address - Fax:813-932-9229
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1214208600000X
NC200200180208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115698605Medicaid
TX115698604Medicaid
TX8M6266OtherBCBS
TX8M6266OtherBCBS
TX115698605Medicaid
TX115698604Medicaid