Healthcare Provider Details

I. General information

NPI: 1700913233
Provider Name (Legal Business Name): CARL RANDALL HARRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34156 US HIGHWAY 19 N
PALM HARBOR FL
34684-2145
US

IV. Provider business mailing address

34156 US HIGHWAY 19 N
PALM HARBOR FL
34684-2145
US

V. Phone/Fax

Practice location:
  • Phone: 727-781-0818
  • Fax: 727-787-7512
Mailing address:
  • Phone: 727-781-0818
  • Fax: 727-787-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0056244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: