Provider Demographics
NPI:1003815929
Name:CARRIZOSA, JAIME (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CARRIZOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 PALM SPRINGS DR
Mailing Address - Street 2:STE. 2A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7853
Mailing Address - Country:US
Mailing Address - Phone:407-830-5577
Mailing Address - Fax:407-830-4164
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:STE. 2A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-830-5577
Practice Address - Fax:407-830-4164
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0038333207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061927200Medicaid
FL061927200Medicaid