Healthcare Provider Details

I. General information

NPI: 1124012927
Provider Name (Legal Business Name): EFRAIN ROSARIO-CARLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15260 NW 147 DRIVE
ALACHUA FL
32615
US

IV. Provider business mailing address

15260 NW 147 DRIVE
ALACHUA FL
32615
US

V. Phone/Fax

Practice location:
  • Phone: 386-418-1222
  • Fax: 386-418-0622
Mailing address:
  • Phone: 386-418-1222
  • Fax: 386-418-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0070112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: