Provider Demographics
NPI:1912161340
Name:TAMAYO, JOSE RAPHAEL G (MD)
Entity type:Individual
Prefix:
First Name:JOSE RAPHAEL
Middle Name:G
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:1127 16TH AVE S # 216
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3213
Practice Address - Country:US
Practice Address - Phone:904-247-7778
Practice Address - Fax:904-390-7389
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 108621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine