Doctor Name: | DR. JOSUE JORGE CARABALLO |
NPI Number: | 1164488540 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | ACN275 |
Business Practice Address: | 480 W Lowder St Macclenny, FL - 320632664 |
Business Phone Number: | 9042596291 |
Business Fax Number: | 9042594761 |
Mailing Address: | 480 W Lowder St, MACCLENNY |
State: | FL |
Postal Code: | 320632664 |
Phone Number: | 9042596291 |
Fax Number: | 9042594761 |
NPI Enumeration Date: | 04/25/2006 |
NPI Last Update Date: | 03/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ACN275 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |