Provider Demographics
NPI:1902936024
Name:JOSE A QUIMBAYO M D P A
Entity Type:Organization
Organization Name:JOSE A QUIMBAYO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:QUIMBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:813-915-0055
Mailing Address - Street 1:3201 W WATERS AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-915-0055
Mailing Address - Fax:813-931-1552
Practice Address - Street 1:3201 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2879
Practice Address - Country:US
Practice Address - Phone:813-915-0055
Practice Address - Fax:813-931-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18671Medicare ID - Type Unspecified
FLE39252Medicare UPIN