Healthcare Provider Details

I. General information

NPI: 1639585284
Provider Name (Legal Business Name): CARLOS QUINTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARLOS ALEJANDRO QUINTERO M.D.

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW COMMERCE DR
LAKE CITY FL
32055-4709
US

IV. Provider business mailing address

6925 NW 121 AVE
ALACHUA FL
32615
US

V. Phone/Fax

Practice location:
  • Phone: 386-719-9000
  • Fax:
Mailing address:
  • Phone: 863-769-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME131658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: