Provider Demographics
NPI:1457305880
Name:URIBE, CARMEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:R
Last Name:URIBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 SW 112TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1976
Mailing Address - Country:US
Mailing Address - Phone:305-383-3848
Mailing Address - Fax:305-383-7601
Practice Address - Street 1:15122 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3228
Practice Address - Country:US
Practice Address - Phone:305-383-3848
Practice Address - Fax:305-383-7601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034811208000000X
FLME348112080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0034811OtherMEDICAL LICENSE
FL039010102Medicaid
FL373907400Medicaid
FL373907400Medicaid
FL95474XMedicare PIN
FL039010102Medicaid
FL24160Medicare PIN