Provider Demographics
NPI:1992738058
Name:COUTINHO, TERTULIANO ZEFERINO (M D)
Entity type:Individual
Prefix:DR
First Name:TERTULIANO
Middle Name:ZEFERINO
Last Name:COUTINHO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CLARK RD
Mailing Address - Street 2:BLDG J SUITE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-921-6093
Mailing Address - Fax:941-923-0243
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:BLDG J SUITE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-921-6093
Practice Address - Fax:941-923-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047260207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042836100Medicaid
FL58489OtherBLUE CROSS OF FLORIDA
FLD86106Medicare UPIN
FL042836100Medicaid