Provider Demographics
NPI:1922302074
Name:MELCHOR M CARBONELL, MD, PA
Entity Type:Organization
Organization Name:MELCHOR M CARBONELL, MD, PA
Other - Org Name:JACKSONVILLE HEIGHTS MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-778-3315
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty