Provider Demographics
NPI:1386916203
Name:EMILE C. COMMEDORE MD, PA
Entity type:Organization
Organization Name:EMILE C. COMMEDORE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COMMEDORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-962-3401
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46393207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty