Provider Demographics
NPI:1356454052
Name:CARLO FONT, JORGE LUIS (M D)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:CARLO FONT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1496
Mailing Address - Country:US
Mailing Address - Phone:787-265-6392
Mailing Address - Fax:
Practice Address - Street 1:EDIF LA PALMA
Practice Address - Street 2:SUITE 2A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-833-0348
Practice Address - Fax:787-805-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR209342OtherPREFERRED HEALTH PLAN
PR601497OtherMMM
PR701997OtherSSBELLAVISTA
PR1035OtherPMC
PR6800041OtherHUMANA INSURANCE
PRPE4721OtherPALIC
PR068506OtherLA CRUZ AZUL
PR2459OtherAMERICAN HEALTH
PR28131CAOtherTRIPLE S
PR37-06840OtherUIA
PR28131OtherS. S. S. OPTIMO
PR601497OtherMMM
PR0028131Medicare ID - Type Unspecified