Provider Demographics
NPI:1023314952
Name:ZAMORA, CARLOS RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-224-5189
Mailing Address - Fax:904-725-1622
Practice Address - Street 1:1747 BAPTIST CLAY DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8502
Practice Address - Country:US
Practice Address - Phone:904-224-5185
Practice Address - Fax:904-278-7284
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 108416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006703700Medicaid
FLP01723356OtherRR MEDICARE
FLGX389XMedicare PIN