Provider Demographics
NPI:1417139486
Name:WALDEMAR TORRES-CARLO MD PA
Entity Type:Organization
Organization Name:WALDEMAR TORRES-CARLO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES-CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-868-5531
Mailing Address - Street 1:PO BOX 47777
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0115
Mailing Address - Country:US
Mailing Address - Phone:813-868-5531
Mailing Address - Fax:813-868-5532
Practice Address - Street 1:4302 N HABANA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6367
Practice Address - Country:US
Practice Address - Phone:813-868-5531
Practice Address - Fax:813-868-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90610207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278403300Medicaid
FLH42649OtherUPIN