Provider Demographics
NPI:1801966452
Name:CARSON, JON (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:CARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4126
Mailing Address - Country:US
Mailing Address - Phone:352-620-8414
Mailing Address - Fax:352-401-9366
Practice Address - Street 1:230 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4126
Practice Address - Country:US
Practice Address - Phone:352-620-8414
Practice Address - Fax:352-401-9366
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069491207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27959OtherBLUE CROSS BLUE SHIELD
FL27959OtherBLUE CROSS BLUE SHIELD
FLF47469Medicare UPIN