Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 13020 | NV |
Y | 111NI0900X | Internist | 13020 | NV |
N | 207RG0300X | Geriatric Medicine | ME91424 | FL |
NPI | 1053371369 |
---|---|
Provider Name | Dr. Raoul I Tamayo |
First Address | Las Vegas, NV 89102-2329 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 25/10/2013 |