Healthcare Provider Details

I. General information

NPI: 1205831880
Provider Name (Legal Business Name): JEFFREY KAY CARLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 RAMON WAY NE
ST PETERSBURG FL
33704-3852
US

IV. Provider business mailing address

3067 TAMIAMI TRL STE 1
PORT CHARLOTTE FL
33952-6619
US

V. Phone/Fax

Practice location:
  • Phone: 727-424-7081
  • Fax: 727-347-5586
Mailing address:
  • Phone: 727-424-7081
  • Fax: 727-347-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME0042583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: