Provider Demographics
NPI:1871749663
Name:TAMIR, JEREMY (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:TAMIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-0454
Mailing Address - Fax:239-343-1075
Practice Address - Street 1:13778 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4301
Practice Address - Country:US
Practice Address - Phone:239-343-0454
Practice Address - Fax:239-343-1075
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32928208200000X
FLME122042208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3434OtherFAMILY NUMBER
FL015497900Medicaid