Basic Information
| Provider Information | |||||||||
| NPI: | 1982691804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAMAYO | ||||||||
| FirstName: | FRANCISCO | ||||||||
| MiddleName: | X | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 MAIN ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463113717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199342461 | ||||||||
| FaxNumber: | 2199342478 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 MAIN ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463113717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199342461 | ||||||||
| FaxNumber: | 2199342478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | E4119 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 01062213 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 45057 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 154226001 | 05 | AR | MEDICAID | 7100300590 | 05 | KY | MEDICAID | 200029330A | 05 | OK | MEDICAID |