Healthcare Provider Details

I. General information

NPI: 1679742993
Provider Name (Legal Business Name): CARLOS A PALACIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS A PALACIO-RAMIREZ

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQ STE 107
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-779-8953
  • Fax: 813-355-5081
Mailing address:
  • Phone: 352-567-0188
  • Fax: 813-355-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME105817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: