Provider Demographics
NPI:1205831880
Name:CARLSON, JEFFREY KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KAY
Last Name:CARLSON
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 1:3067 TAMIAMI TRL
Mailing Address - Street 2:STE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6619
Mailing Address - Country:US
Mailing Address - Phone:727-424-7081
Mailing Address - Fax:727-347-5586
Practice Address - Street 1:156 RAMON WAY NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3852
Practice Address - Country:US
Practice Address - Phone:727-424-7081
Practice Address - Fax:727-347-5586
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040532900Medicaid
FL62519Medicare ID - Type Unspecified
FLD57481Medicare UPIN