| Entity Name: | RAUL E. TAMAYO, P.L. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 May 2002 (23 years ago) |
| Document Number: | L02000012803 |
| FEI/EIN Number | 043679974 |
| Address: | 280 WEKIVA SPRINGS RD., SUITE 1000, LONGWOOD, FL, 32779 |
| Mail Address: | 280 WEKIVA SPRINGS RD., SUITE 1000, LONGWOOD, FL, 32779 |
| ZIP code: | 32779 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265572028 | 2007-02-08 | 2020-05-28 | 280 WEKIVA SPRINGS RD, SUITE 1000, LONGWOOD, FL, 327795946, US | 280 WEKIVA SPRINGS RD, SUITE 1000, LONGWOOD, FL, 327795946, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-460-5722 |
| Fax | 4073892273 |
Authorized person
| Name | DR. RAUL E TAMAYO |
| Role | MEDICAL DIRECTOR |
| Phone | 4077882273 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0050911 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0601699100 |
| State | FL |
| Issuer | GROUP NPI NUMBER |
| Number | 1265572028 |
| State | FL |
| Issuer | DR. TAMAYO SOCIAL SEC |
| Number | $$$$$$$$$ |
| State | FL |
| Issuer | GROUP BCBS NUMBER |
| Number | 72774 |
| State | FL |
| Issuer | DR. TAMAYO NPI NUMBER |
| Number | 1568437689 |
| State | FL |
| Issuer | DR TAMAYO BCBS INDIVIDUAL |
| Number | 04355 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TAMAYO RAUL E | Agent | 280 WEKIVA SPRINGS RD, LONGWOOD, FL, 32779 |
| Name | Role | Address |
|---|---|---|
| TAMAYO RAUL E | Manager | 280 WEKIVA SPRINGS RD., STE 1000, LONGWOOD, FL, 32779 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
