Provider Demographics
NPI:1275885477
Name:CITRON, CARL STANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:STANTON
Last Name:CITRON
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 1:9236 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5230
Mailing Address - Country:US
Mailing Address - Phone:954-609-0589
Mailing Address - Fax:954-474-4481
Practice Address - Street 1:9236 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5230
Practice Address - Country:US
Practice Address - Phone:954-609-0589
Practice Address - Fax:954-474-4481
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40007207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0488429-01Medicaid
FLD27798Medicare UPIN
FL0488429-01Medicaid