Provider Demographics
NPI:1952415960
Name:COMMEDORE, EMILE C (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:C
Last Name:COMMEDORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 271386
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-1386
Mailing Address - Country:US
Mailing Address - Phone:813-962-3401
Mailing Address - Fax:813-962-3401
Practice Address - Street 1:6940 W LINEBAUGH AVE
Practice Address - Street 2:101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5823
Practice Address - Country:US
Practice Address - Phone:813-962-3401
Practice Address - Fax:813-962-3401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46393207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30889Medicare ID - Type Unspecified
FLD54156Medicare UPIN