Healthcare Provider Details

I. General information

NPI: 1154407393
Provider Name (Legal Business Name): CARLOS A HIDALGO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 EAST BOYER ST
TARPON SPRINGS FL
34689
US

IV. Provider business mailing address

1007 EAST BOYER ST
TARPON SPRINGS FL
34689
US

V. Phone/Fax

Practice location:
  • Phone: 727-772-5982
  • Fax: 727-772-0693
Mailing address:
  • Phone: 727-772-5982
  • Fax: 727-772-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0055862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: