Provider Demographics
NPI:1952778276
Name:CARRION, JOSE (PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CARRION
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 KIRBY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-3454
Mailing Address - Country:US
Mailing Address - Phone:954-330-6041
Mailing Address - Fax:
Practice Address - Street 1:61 POMEROY AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7483
Practice Address - Country:US
Practice Address - Phone:203-694-5340
Practice Address - Fax:203-694-5385
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2825363A00000X, 363AM0700X
CT6097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical