Provider Demographics
NPI:1265481964
Name:CARRIL, RAUL A (PA)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:CARRIL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 TURKEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4202
Mailing Address - Country:US
Mailing Address - Phone:407-288-8080
Mailing Address - Fax:407-352-0104
Practice Address - Street 1:5948 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4202
Practice Address - Country:US
Practice Address - Phone:407-288-8080
Practice Address - Fax:407-352-0104
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373793400Medicaid
FLE3385ZMedicare PIN
FLS94337Medicare UPIN