Provider Demographics
NPI:1184686586
Name:ESTEVEZ, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:ESTEVEZ
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 1:560 JACKSON ST N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1405
Mailing Address - Country:US
Mailing Address - Phone:727-329-1600
Mailing Address - Fax:727-329-1694
Practice Address - Street 1:560 JACKSON ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1405
Practice Address - Country:US
Practice Address - Phone:727-329-1600
Practice Address - Fax:727-329-1694
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25372174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55506100Medicaid
FL52876OtherBCBS
FLP00913579OtherRAILROAD MEDICARE
FL52876WMedicare PIN
D56303Medicare UPIN