Provider Demographics
NPI:1801873443
Name:CARLOS, PERRY G (DO)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:G
Last Name:CARLOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:10337 SAN JOSE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8223
Practice Address - Country:US
Practice Address - Phone:904-260-3200
Practice Address - Fax:904-262-8205
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2019-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS3973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080162819OtherRR MEDICARE
FL3767451-00Medicaid
FL82278XMedicare PIN
D60617Medicare UPIN