Provider Demographics
NPI:1225263890
Name:EDUARDO CARMONA MD PA
Entity Type:Organization
Organization Name:EDUARDO CARMONA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-815-0316
Mailing Address - Street 1:PO BOX 510083
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0083
Mailing Address - Country:US
Mailing Address - Phone:941-815-0316
Mailing Address - Fax:941-347-7282
Practice Address - Street 1:20020 VETERANS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2112
Practice Address - Country:US
Practice Address - Phone:941-815-0316
Practice Address - Fax:941-347-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME986062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty