Provider Demographics
NPI:1417027566
Name:CARBONELL, MELCHOR (MD)
Entity Type:Individual
Prefix:
First Name:MELCHOR
Middle Name:
Last Name:CARBONELL
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 1:7450 103RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6780
Mailing Address - Country:US
Mailing Address - Phone:904-778-3315
Mailing Address - Fax:904-778-3314
Practice Address - Street 1:7450 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6780
Practice Address - Country:US
Practice Address - Phone:904-778-3315
Practice Address - Fax:904-778-3314
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119103900Medicaid
FL15342OtherBLUE CROSS BLUE SHIELD
FLD85109Medicare UPIN
FL15342Medicare ID - Type Unspecified