Healthcare Provider Details

I. General information

NPI: 1659489581
Provider Name (Legal Business Name): LUIS ALBERTO CARRASCOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 SW 49TH PL
OCALA FL
34474-9673
US

IV. Provider business mailing address

PO BOX 102222 ATTN CREDENTIALING DEPT
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-9430
  • Fax: 352-237-9698
Mailing address:
  • Phone: 239-274-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME99167
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberME99167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: