Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME67033 | FL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME67033 | FL |
NPI | 1376547059 |
---|---|
Provider Name | Hiram Carrasquillo |
First Address | Jacksonville, FL 32207-8566 |
Second Address | Jacksonville, FL 32207-8566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376097900 | (05) | FL |
F79953 | (02) | FL |