Healthcare Provider Details

I. General information

NPI: 1912075755
Provider Name (Legal Business Name): JOHN C CARROZZELLA II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 DR PHILLIPS BLVD SUITE 370
ORLANDO FL
32819-7216
US

IV. Provider business mailing address

7575 DR PHILLIPS BLVD SUITE 370
ORLANDO FL
32819-7216
US

V. Phone/Fax

Practice location:
  • Phone: 407-507-3837
  • Fax: 407-507-3841
Mailing address:
  • Phone: 407-507-3837
  • Fax: 407-507-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME58908
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME58908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: